Volume 36 · Issue 03 · 2020

Since December 2019, novel coronavirus pneumonia has spread rapidly in China. This paper expounds the characteristics and principles of prevention and control of novel coronavirus pneumonia, and summarizes the prevention and control strategies of neurosurgery for novel coronavirus pneumonia combined with the experience of our center, in order to help medical staff to prepare for epidemic prevention.

To investigate the expression of microchromosome maintenance protein 10(MCM10) in thalamic gliomas and its prognostic value.

A retrospective analysis was conducted on the clinical data of 48 patients with thalamic glioma who underwent tumor resection at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from September 2016 to September 2017. At 1 week post operation, the degree of tumor resection was determined according to cranial MRI. After discharge, all patients underwent follow-up by outpatient clinic visits or telephone, which included reexamination of skull enhanced MRI and assessment of Karnofsky performance scale(KPS) score. All tumor tissues were reserved during operation for immunohistochemical staining analysis of MCM10. According to the positive rate of MCM10 expression and comprehensive score of staining intensity, the lower expression of MCM10 was decided as less than 6 points, and the higher expression of MCM10 as at least 6 points. The expression of MCM10 in different grade thalamic gliomas was analyzed. We then compared the clinical data of MCM10 low expression group and high expression group. The survival of two groups was further analyzed using Kaplan-Meier method. Finally, the univariate and multivariate Cox regression analysis methods were used to determine whether MCM10 was an independent risk factor affecting the total survival of thalamic glioma patients.

In 48 patients, 1 week after surgery, the cranial MRI showed that total resection was achieved in 13 cases (27.1%), near-total resection in 29 cases (60.4%) and partial resection in 6 cases (12.5%). The median follow-up time was 22.6 months (0.3-34.2 months) in 48 patients. Three months after surgery, the median KPS score was 60 points(0-100 points). By the end of the follow-up period, 31 of the 48 patients survived and 17 died. The results of immunohistochemistry showed that the tumor tissue in 48 patients expressed MCM10, of which 23 (47.9%) were low expression and 25 (52.1%) were high expression. Immunohistochemistry analysis in the 48 patients of thalamic gliomas with various World Health Organization (WHO) grades showed that MCM10 had the lowest staining points (3.7±1.2) in grade Ⅰ glioma, middle-level in grade Ⅱ (5.8±2.3) and grade Ⅲ(7.5±3.5), and the highest in grade Ⅳ (7.9±2.8). The difference between groups was statistically significant (P=0.021). The differences in age, sex, WHO grade, preoperative KPS score and postoperative recurrence of MCM10 high expression group and low expression group were not statistically significant (all P>0.05). The survival rate and KPS score improvement were significantly higher in the patients of MCM10 low expression group than those in the high expression group (bothP<0.05). The results of univariate and multivariate Cox regression analysis showed that MCM10 high expression was one of the independent risk factors affecting the outcome of patients with thalamic glioma (HR=0.129, 95% CI: 0.024-0.685, P=0.016).

MCM10 is expressed in thalamic glioma with the lowest level in WHO Ⅰ grade tumor and the highest in grade Ⅳ. Longer survival is associated with low expression of MCM10, which can be used as an indicator of the prognosis judgment of thalamic glioma.

To explore the pathological characteristics of recurrent glioma and its relationship with the patient′s prognosis.

A retrospective analysis was conducted on the clinical data of 54 patients with recurrent glioma treated at Neurosurgery Department, Sun Yat-sen University Cancer Center from August 2002 to December 2016. All patients underwent a second operation of tumor resection and postoperative pathological examinations including the World Health Organization (WHO) classification of the tumor, Ki-67 index, O⁶-methylguanine-DNA-methyltransferase (MGMT) status and isocitrate dehydrogenase 1 (IDH1) status. The histopathological features of recurrent samples were classified according to presence of necrosis and tumor cells as well as activity of tumor cells. The overall survival (OS) of patients was analyzed using the Kaplan-Meier method. The univariate and multivariate Cox regression analysis was further conducted to determine the clinical factors affecting OS in patients with recurrent glioma.

Pathological test results in 54 patients were as follows: (1) In terms of WHO grade, there were 6 cases of grade Ⅱ(11.1%), 14 cases of grade Ⅲ(25.9%), 30 cases of grade Ⅳ(55.6%), and 4 cases (7.4%) without tumor cells. Compared with the first operation, there was no change in the WHO grade in 32 patients (59.2%), 7 (13.0%) had lower WHO tumor grades and 15 (27.8%) had higher grades; (2) In terms of Ki-67 index, out of 32 cases undergoing two times of testing, 15 cases had decreased Ki-67 index, 14 had increased Ki-67 index, and 3 cases had unchanged index; (3) In terms of IDH1 status, out of 29 cases undergoing two times of relevant tests, 9 cases were mutant and 20 were wild type; (4) In terms of MGMT status: out of 8 cases undergoing two times of relevant tests, 6 cases consisting of 3 cases with positive expression and 3 cases with negative expression had no change, and the remaining 2 changed from positive expression in the first test to negative expression in the second test; (5) In terms of pathological classification, 4 cases were necrosis type, 20 were mixed type, and 30 were active type. The follow-up time of 54 patients was 16.1±3.2 months (1.3-160.3 months). The Kaplan-Meier analysis showed a median OS of 14.4 months in 54 patients. The result of multivariate Cox regression analysis showed that high WHO grade of recurrence tumor (HR=2.80, 95% CI: 1.42-5.53, P<0.01) and absence of postoperative radiotherapy (HR=4.05, 95% CI: 1.41-11.64, P=0.01) were independent risk factors affecting OS in patients with recurrent glioma.

This preliminary study has suggested that recurrent gliomas might have changed pathological results revealed post re-surgery, and low WHO tumor grade and postoperative radiotherapy seem to be predictive factors of better prognosis.

To explore the relationship between craniopharyngioma based on QST classification with invovlement of the third ventricle floor and the third ventricle floor meninges and its clinical significance.

The clinical data of 17 primary craniopharyngioma patients with involvement of the third ventricle floor (6 cases of Q type, 3 cases of S type and 8 cases of T type) undergoing total tumor resection under neuroendoscopy from January 2018 to October 2019 at Neurosurgery Department of Nanfang Hospital, Southern Medical University were retrospectively analyzed. Tumor tissue samples were taken from all patients during operation. The specimens of the normal sellar region were derived from the fetus (8 cases) of the artificial or spontaneous abortion at Nanfang Hospital of Southern Medical University during the same period. Samples were stained by hematoxylin eosin (HE) and immunofluorescence double staining. The dura was labelled with vimentin antibody, arachnoid with type I collagen antibody, pia with glial fibrillary acidic protein antibody and laminin antibody, adenohypophysis with CK18 antibody and craniopharyngioma with CK5 / 6 antibody. We then observed the meningeal staining of fetal brain tissue and relationship between different QST types of craniopharyngioma tissue and the third ventricle floor meninges.

The dura mater, arachnoid and pia mater of 8 fetuses were labelled successfully. HE staining and immunofluorescence double staining of craniopharyngioma showed that in type Q tumor (6/6), there were dura mater (diaphragma sellae) between tumor and the third ventricle floor. In type S tumor (3/3), there were arachnoid membrane and pia mater between tumor and the third ventricle floor. There were 3 patterns regarding the relationship between type T tumor and the third ventricle floor: mantle-like relationship, moat-like and mortise-like types. There was pia mater between type T tumor (8/8) and the third ventricle floor, and the pia mater could gradually disappear at the origin point of tumor. Although the tumor could remarkably compress the third ventricle and occupy the space of ventricle, the ependymal layer of the third ventricle remained intact.

All QST types of craniopharyngioma could involve the third ventricle floor and there are various membrane layers between tumor and the third ventricle floor, which could provide natural interface for safe removal of craniopharyngioma with the third ventricle floor involvement.

To explore the clinical study of the extent of pyramidal tract invasion and the postoperative outcome of insular gliomas.

The clinical data of 41 patients with insular glioma undergoing surgical treatment from July 2010 to July 2019 at Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) were retrospectively analyzed. Patients were classified into 3 types according to the degree of invasion of pyramidal tracts. The tumor invading only the anterior lower part of the insular lobe was categorized as type Ⅰ, that invading posterior upper part of the insular lobe as type Ⅱ, and that with invasion and destruction of the inner capsule structure as type Ⅲ. The differences of limb motor dysfunction before and after operation, pathological types and postoperative outcome among patients with different types were analyzed.

Among the 41 patients, 18 were type Ⅰ (43.9%), 20 were type Ⅱ (48.8%), and 3 were type Ⅲ (7.3%). No type Ⅰ patients had motor impairment before or after surgery. Four patients with type Ⅱ tumor had motor dysfunction before surgery, of whom 3 reported improvement after surgery and 1 developed further worsened symptoms. One type Ⅱ patient had new motor dysfunction after surgery. Type Ⅲ patients had motor dysfunction before operation, and their symptoms worsened after operation. There were 11 cases, 5 cases, and 1 case of total resection of type Ⅰ, type Ⅱ, and type Ⅲ tumors, respectively. Compared with the rate of total resection in type Ⅰ patients, that in type Ⅱ+ Ⅲ patients was significantly lower[26.1% (6/23) vs. 11/18, P=0.026]. There were 3 cases, 7 cases, and 3 cases of World Health Organization (WHO) grade Ⅲ-Ⅳ glioma in patients of type Ⅰ, Ⅱ and Ⅲ, respectively. The difference was statistically significant (P=0.015). A total of 29 cases were followed up for 3-72 months (22.7±12.0 months). Thirteen patients with type Ⅰ were followed up, and none of them recurred. Fifteen patients with type Ⅱ were followed up, 7 of whom relapsed. One patient with type Ⅲ was followed up, and the residual tumor increased and the patient died in the third month after operation. Kaplan-Meier survival analysis revealed significant difference in the survival rate among the patients of 3 types (P<0.01).

The heavier the pyramidal tacts is invaded, the higher the pathological grade of insular glioma, the lower the total surgical resection rate, and the worse the postoperative outcome.

To investigate the method and effect of microsurgical removal of large and giant parasagittal meningioma invading the superior sagittal sinus.

The clinical data of 154 cases with large and giant parasagittal meningioma invading the superior sagittal sinus admitted to Department of Neurosurgery, Peking University Third Hospital from May 2009 to May 2019 were retrospectively analyzed. The diameter of the tumors ranged from 4 cm to 8 cm, with an average of 5.5±1.2 cm. Microsurgical resection was carried out along the midline and longitudinal fissure with a horse-shoe shaped skin incision turning to the temporal side. The degree of resection was evaluated by Simpson grading system. The results of clinical follow-up were evaluated by Karnofsky performance score (KPS), and the tumor recurrence was evaluated by imaging follow-up.

Among the 154 cases, Simpson grade Ⅰ resection was achieved in 112 (72.7%) and grade Ⅱ resection in 42 cases (27.3%). All of them were proved to be meningiomas (World Health Organization grade Ⅰ). The operation time ranged from 30 minutes to 210 minutes (median: 60 minutes), and the length of stay ranged from 5 days to 10 days with an average of 7.2±1.1 days. There was no infection, cerebrospinal fluid leakage, death or permanent aggravation of neurological dysfunction. The patients were followed up for 3 months to 123 months, with an average of 63.5±0.7 months. The KPS score ranged from 80 points to 100 points, with an average of 93.6±0.3 points. Tumor recurrence occurred in 14 patients (9.1%), including 7 in Simpson Ⅰ resection group and 7 in Simpson Ⅱ resection group. There was significant difference in recurrence rate between the 2 groups (χ²=4.01, P<0.05).

Simpson grade Ⅰ microsurgical resection can be pursued for large and giant parasagittal meningioma invading the superior sagittal sinus which helps minimize the recurrence rate.

To analyze the methodology parameters of intraoperative monitoring of flash visual evoked potential (F-VEP) and to explore its application value in the operation of sellar region tumors.

The clinical data of 117 patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2018 to August 2019 were retrospectively analyzed. A total of 86 patients with intraductal space-occupying lesions were enrolled as A group (112 eyes) for the study of intraoperative F-VEP parameters. The stable parameters obtained from the parameter study were applied to 31 patients with sellar region tumors (B group, 62 eyes). All patients underwent tumor resection and intraoperative F-VEP monitoring under general intravenous anesthesia. F-VEP amplitudes under various electrode channels and different stimulus frequencies (0.7-1.2 Hz) were compared.

In the A group, at any stimulation frequencies, the amplitude between N75 and P100 wave (A1) of O2-Fz channel and Oz-Fz channel were significantly higher than those of O1-Fz channel (all P<0.05). At various stimulus frequencies within the range of 0.7-1.0 Hz, the amplitude of A2 of O2-Fz channel and Oz-Fz channel was significantly higher than those of O1-Fz channel (allP<0.05). In any electrode channel, A1 obtained at various stimulus frequencies within the range of 0.7-1.2 Hz did not vary significantly, while A2 at the frequency of 0.7 Hz was significantly higher than that at any other frequency (allP<0.05). In the B group, the stable F-VEP waveform was obtained in 61 eyes with an extraction rate of 98.4% (61/62). There was no change in F-VEP waveform in 19 patients in the B group, of which 13 had the same visual function as that before operation, and 6 of them had improved visual function. In the B group, among the 12 patients with reversible F-VEP waveform, 4 had the same visual function as that before surgery, 7 had improved visual function, and only 1 had decreased visual function.

After selecting appropriate stimulus parameters, stable and reliable F-VEP waveform can be obtained during operation. By means of preliminary application of F-VEP monitoring in sellar region tumor surgery, it has been preliminarily confirmed that intraoperative F-VEP monitoring could be used to predict the prognosis of postoperative visual function in patients.

To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma.

A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate.

Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection.

Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma .

To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD.

A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored.

In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD.

The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases.

To address the value of multimodal image-based virtual reality technology in preoperative evaluation of resection of brain tumor in central cortex and adjacent areas.

A retrospective study was conducted on the clinical data of 36 patients with brain tumor in central cortex and adjacent areas who were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University from December 2015 to April 2018. All patients underwent preoperative 3.0T MRI scan. Multimodal MRI images were then co-registered with the software iPlan followed by three-dimensional image reconstruction to generate virtual reality images. Evaluation of the relationship between tumor, brain vessels and eloquent areas was then performed according to the virtual reality model and compared with intra-operative findings. The brain tumors were resected under craniotomy microscope. Medical imaging examination and follow-up were performed after operation.

For prediction of the relationship between tumor, eloquent area and vessels, multimodal image-based virtual reality showed the sensitivity of 94.4% (34/36). Among all 36 patients, total resection of glioma was achieved in 16 cases and subtotal resection in 2; total resection of meningioma was performed in 9 cases and subtotal resection in 1; total resection was achieved in 5 cases of cavernous hemangioma, 2 cases of metastatic tumor and 1 case of lymphoma. After surgery, 3 patients developed different degrees of limb motor impairment, of which 2 returned to normal after 3 months. One case developed transient speech disorders after surgery and returned to normal after 1 week. All patients were followed up for 20.2±5.4 months (10-38 months), and there were 3 patients showing recurrence in imaging examination.

The use of virtual reality technology is helpful to make an accurate assessment of the relationship between tumor and eloquent area as well as blood vessels near the tumor before surgery, and can help to improve the preoperative plan and improve the rate of total removal of tumor, thereby reducing the occurrence of postoperative complications.

To evaluate the safety and efficacy of flow diverter (FD) in the treatment of large (maximum diameter≥10 mm) unruptured intracranial aneurysms.

A total of 92 patients harboring 95 large unruptured intracranial aneurysms who underwent treatment with FD (Pipeline + Tubridge) at Department of Cerebrovascular Intervention, Zhengzhou University People's Hospital, Henan Provincial People's Hospital from February 2015 to July 2019 were enrolled into this retrospective study. The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at follow-up, and O′Kelly-Marotta (OKM) grading scale was used to evaluate the occlusion of aneurysm. Multivariate logistic regression analysis was used to explore the influencing factors which could affect the aneurysm occlusion rate at 6-month follow-up.

A total of 101 devices of FD were employed in 92 patients with 95 aneurysms, all of whom underwent successful operation. The incidence of neurological complications was 4.3% (4/92), which included 1 case of thromboembolic complication, 2 hemorrhagic events (1 death) and 1 case of postoperative irritability. Seventy-seven patients obtained clinical follow-up with a median of 12 (1-51) months. The mRS was 0 in 70 patients, 1 in 5, 2 in 1 and 3 in 1. There were 55 patients with 56 aneurysms who underwent the latest follow-up at a median of 6 (3-29) months post operation, and the complete occlusion (Grade D of OKM grading scale) rate was 71.4% (40/56), the in-stent stenosis rat was 7.1%(4/56). There were 52 patients with 53 aneurysms who obtained the 6-month imaging follow-up and the complete occlusion rate was 64.2% (34/53), the in-stent stenosis rat was 7.5%(4/53). Multivariate logistic regression showed that adjunctive coiling was the independent factor which affected the aneurysm occlusion rate at 6-month follow-up significantly (OR=8.98, 95% CI: 1.87-43.22, P=0.006).

The use of FD seems safe in the treatment of large unruptured intracranial aneurysms with a high procedure success rate. However, serious complications remain to be noted. Meanwhile, adjunctive coiling could promote the complete occlusion of intracranial aneurysms.

To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) in stenosis stenting for symptomatic middle cerebral artery.

The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery (MCA) M1 segment who were treated with stenting therapy (stenting angioplasty) at Department of Neurosurgery, Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively. HRMR-VWI results were used to evaluate the location, composition and stability of plaques before operation. The mortality and morbidity at 30 days post operation were determined by clinical follow-up. The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up.

The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall, those in 12 on the inferior, and those in 8 on the upper vessel wall. Seven patients had unstable plaques in the M1 segment of MCA. The stents were successfully placed in 35 patients and well adhered with smooth blood flow. Technical complications occurred in 2 (5.7%) patients. One patient (2.8%) died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery, although decompressive craniectomy and hematoma clearing were performed. One patient (2.8%) had residual neurological dysfunction. Twelve months after the operation, no ischemic stroke occurred in 34 patients, and no restenosis occurred in the 5 patients who were followed up by imaging.

HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA, which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis.

To retrospectively analyze the predictive effects of thromboelastography (TEG) and routine coagulation function (CCAs) tests on death within 30 days in patients with craniocerebral trauma (TBI) in the acute phase. Of the 51 patients included, 24 (47.1%) patients with hypocoagulable status were screened by CCAs and 5 (20.8%) by TEG. Twelve died and 39 survived within 30 days of admission. Multivariate logistic regression analysis showed that the international standardized ratio (OR＝340.106，95%CI：100.496～734.972，P=0.035) and prothrombin activity (OR＝1.616，95%CI：1.036～2.521，P=0.034) was an independent influencing factor in death within 30 days in patients with TBI. However, none of the parameters in TEG was a factor affecting the patient's death within 30 days.

To study the expression of ubiquitin-specific protease 25 (USP25) in the temporal cortex of the kainic acid (KA) induced epilepsy rat model.

Fifty-two male SD rats were randomly divided into the epilepsy model group (n=39) and sham-operated control group (n=13) with the random number table. The epilepsy model group was established by injecting KA into the amygdala, then the epileptic rats were randomly divided into 3 groups according to the modeling success time: 1 day for acute period, 7 days for latent period and 30 days for chronic period (13 rats in each group). Those rats were sampled at the end of observation. Rats in the control group were injected with normal saline into the amygdala and sampled together with those in the experimental group. Immunohistochemistry and immunofluorescence double labeling was used to test USP25 expression and its co-expression with neurons (NeuN) and astrocytes (GFAP). Quantitative real-time PCR and Western blot were used to assess the change of USP25 in the temporal cortex of rats.

In the ipsilateral temporal cortex, the positive cells of co-expression of USP25 and NeuN were increased in the later stage of epilepsy in the epilepsy model group, and the expression levels of USP25 mRNA and protein in different stages of epilepsy varied significantly (F= 25.48 and 7.68 respectively, both P<0.05). Compared with the control group (mRNA level: 1.00±0.36, protein level: 1.00±0.46), the expression of USP25 in the latent group (mRNA level: 10.80±4.82, protein level: 1.88±0.32) and the chronic group (mRNA level: 12.97±4.48, protein level: 1.92±0.26) were increased significantly (allP<0.05). In the contralateral temporal cortex, the expression levels of USP25 mRNA and protein in different stages of epilepsy also varied significantly (F=86.86 and 6.65 respectively, both P<0.05).

The increased expression of USP25 in the temporal cortex after the latent period has suggested that the deubiquitination pathway is involved in the chronic pathological process of temporal lobe epilepsy.

To investigate the molecular and clinical features of PDK1 (pyruvate dehydrogenase kinase 1) in gliomas based on the Cancer Genome Atlas (TCGA) by bioinformatics analysis.

The clinical data of 641 glioma patients in TCGA database were retrospectively analyzed. The online analysis website of GEPIA (http: //gepia.cancer-pku.cn/) was used to analyze PDK1 expression in glioma patients. Pearson correlation analysis was performed to create a gene list related to PDK1. The online analysis tool STRING was used to analyze the interaction network of the differential genes. According to the degree of confidence, the top key proteins were screened. The function of PDK1-related differential genes and its relationship with the kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were explored by gene ontology (GO) analysis. According to PDK1 protein expression, all patients were divided into PDK1 protein low expression group (380 cases) and PDK1 protein high expression group (261 cases). Kaplan-Meier survival curves were used to compare the survival differences between the two groups of patients. Univariate and multivariate Cox regression analysis were used to determine the effect of PDK1 protein expression on the prognosis of patients with glioma.

The expression of PDK1 protein in 641 glioma patients in TCGA database showed that the expression level in the World Health Organization(WHO) Ⅳ glioma (8.86±0.90) was higher than that in grade Ⅱ (7.24±0.60) and grade Ⅲ (7.34±0.80)(P<0.05), and the difference between expression levels in grade Ⅱ and grade Ⅲ glioma patients was not statistically significant(P>0.05). The cumulative survival rate of glioma patients in the PDK1 high-expression group was significantly lower than that in the PDK1 low-expression group (P<0.05). Pearson correlation test analysis revealed that 96 genes were closely related to PDK1 expression, of which 69 were positively correlated and 27 were negatively correlated. GO analysis and KEGG pathway analysis showed that PDK1 participated in many important biological processes, which were closely related to the hypoxia microenvironment, reaction to organic cyclic compounds, reaction to organic nitrogen compounds, response to cAMP and the HIF-1 signaling pathway. Multivariate analysis showed that age (HR=1.579, 95% CI: 1.085-2.299, P=0.017), WHO grade (HR=12.106, 95% CI: 6.521-22.474, P<0.001) and radiotherapy (HR=0.502, 95% CI: 0.325-0.775, P=0.002) were independent influencing factors for the survival of glioma patients (all P <0.05) and could be used independently to explore the prognosis of patients.However, PDK1 protein expression does not affect the prognosis of glioma patients.

PDK1 expression is different in glioma patients with different WHO pathological levels, and mainly related to hypoxia and HIF-1 signaling pathway.

To investigate the mechanism of matrix stiffness promoting epithelial-mesenchymal transformation (EMT) and vasculogenic mimicry (VM) of glioma cells by yes-related proteins (YAP).

Human glioma U87 cell lines were cultured under different matrix stiffness conditions. Matrix stiffness 0.2, 16.0 and 64.0 kPa represented normal brain, glioma and extreme stiffness, respectively. CCK-assay was used to examine the proliferation of U87 cell line.The localization of YAP cells was detected by immunofluorescence staining. The expression of YAP targeting genes including CTGF and CRY61 were detected by real-time quantitative PCR. The expression and phosphorylation expression of YAP, proliferation signal including Akt and ERK1/2 were detected by Western blot. Immunofluorescence and Western blot were used to detect the expression of EMT-related proteins including Vimentin, E-cadherin and Twist. VM formation was detected in soft and stiff substrates under 3D culture. U87 cells were transfected with shYAP lentivirus, and then the expression of EMT proteins and VM formation were examined.

With the increase of matrix stiffness, the proliferation activity of glioma cells and phosphorylation expression of Akt and ERK1/2 were increased (all P<0.05), the expression of phosphorylated Yap was decreased (P<0.05), while the expression levels of CTGF and CRY61 were increased (bothP<0.05) as the nuclear translocation of YAP was increased. The results of immunofluorescence staining and Western blot showed that with the increase of matrix stiffness, the EMT component expression levels of Vimentin and Twist were increased, the epithelial marker E-cadherin was decreased (allP<0.05). Compared with that under soft matrix 3D culture, the formation of VM tubular structure in U87 cells was increased in stiff matrix (P<0.05). Interference with Yap expression inhibited the enhancement of the proliferation of glioma cells, the expression of Vimentin and Twist, and VM formation induced by matrix stiffness (allP<0.05).

Matrix stiffness promotes the proliferation of glioma cells, EMT and VM formation through YAP. Targeted matrix stiffness and YAP can be used as new strategies for glioma treatment.

Carotid endarterectomy can effectively prevent the occurrence of ischemic cerebrovascular disease. This study summarized the surgical procedures of single-center micro-carotid endarterectomy in order to promote the standardized operation and technical exchange during the operation.

Meningeal hemangiomatosis (MA) is a rare disease characterized by the proliferation of small blood vessels, meningioma cells and fibroblasts in the cerebral cortex, mostly located in the frontal and temporal lobes. The incidence of some cases may be related to type II neurofibromatosis (NF2). Clinically, it is often divided intoNF2 mutant and sporadic. The tumors of the two children with MA reported in this paper were located in the supratentorial cerebellum, and the glioma may be considered in the preoperative imaging diagnosis. The expression of CD31, Ki67 and P53 were all positive by immunohistochemistry, but no gene was detectedNF2 mutation. All the tumors were totally resected, and the follow-up until now showed no seizures, and the prognosis was good.

Glioma is the most common malignant tumor in the cranium, and the insula lobe is one of the most common sites of glioma. Because of its deep location, it is surrounded by important blood vessels and nerve fiber bundles, which is related to emotion, memory, visceral sensation, movement, language and other functions. At the same time, glioma itself is extremely aggressive, so patients with insula glioma are prone to dysfunction. In recent years, imaging examination technology has developed rapidly, and magnetic resonance diffusion tensor imaging (DTI) and diffusion tensor fiber bundle imaging (DTT) have been widely used in the diagnosis and treatment of insular glioma. In this paper, the related research of DTI applied to insular glioma was reviewed, in order to provide reference for clinical diagnosis and treatment.

Epilepsy is a chronic neurological disease with recurrent seizures. The vast majority (about 70%) of seizures can be controlled by using antiepileptic drugs, but some patients are still difficult to control by drug treatment, that is, refractory epilepsy. Usually, surgical resection of epileptic lesions is used for treatment, but there are still many patients with refractory epilepsy in clinic who cannot undergo surgery for many reasons. For these patients, nerve stimulation can be selected for treatment. There are many kinds of nerve stimulation, which are relatively targeted, adjustable and persistent. At present, it is mainly used to treat pain, dyskinesia, tremor, epilepsy and other diseases. This article reviews the related research of neurostimulation in the treatment of epilepsy.

Cerebral arteriovenous malformation (bAVM) is one of the complex hemorrhagic cerebrovascular diseases, which is the result of abnormal vascular development caused by the combination of genes, cytokines and proteins under the influence of various internal and external environments in embryonic period. However, the specific biological mechanism leading to the occurrence and development of bAVM is still unclear. Understanding the mechanism of its pathogenesis is of great significance for preventing the occurrence and development of bAVM, developing targeted drugs and guiding clinical intervention. This paper reviews the molecular biological mechanism of bAVM from the perspective of molecular biology, including genes, cytokines, proteins and signaling pathways.

With the continuous development of interventional embolization technique, clinical trials have proved that the use of spring coil embolization of intracranial aneurysm can achieve good initial results. Therefore, an increasing number of treatment centers are using interventional embolization as the first choice for the treatment of intracranial aneurysms. However, there is a high recurrence rate after interventional embolization of intracranial aneurysms. Many studies have shown that it is safe and effective to use interventional embolization technique to retreat patients with intracranial aneurysms who recurred after embolization; In addition, craniotomy clipping is also an alternative method, especially in intracranial aneurysms with tumor instability or space-occupying effect after early transembolization treatment. This article reviews the epidemiological characteristics of recurrent intracranial aneurysms after interventional embolization, the related factors of recurrence and the indication of retreatment, and emphasizes the research progress of craniotomy and clipping in the treatment of recurrent intracranial aneurysms after embolization.

Cerebral cavernous vascular malformation (CCM) is a common clinical intracranial vascular malformation. At present, three main disease-causing genes have been identified:CCM1、CCM2 andCCM3。 With the in-depth research on the pathogenic mechanism of CCM, more and more pathogenic related signaling pathways and drug therapeutic targets have been discovered. Some drugs showed good therapeutic effects on CCM. Based on different gene mutations, different signaling pathways and specific therapeutic targets, this paper summarizes the potential therapeutic drugs for CCM and expounds their signaling pathways, which provides a theoretical basis for further research and drug therapy.