Volume 36 · Issue 04 · 2020

Parkinson's disease (PD) is a neurodegenerative disease of middle-aged and elderly patients with tremor, myotonia, retardation and postural balance disorder as the main manifestations. Drug therapy in early PD was obviously effective, but after long-term oral drug therapy, the efficacy decreased and motor complications gradually appeared^[1]。 deep brain stimulation (DBS) appeared in the 1970s. It is to implant stimulation electrodes in the nuclei or specific brain regions of the brain, and regulate the functions of related nuclei or brain regions through pulse electrical stimulation to achieve the purpose of improving symptoms. In 1987, Benabid of France applied DBS to the treatment of movement disorders, and it has been more than 30 years since then. This therapy was first used in China in 1998 and has been widely carried out in China^[2]。

To investigate the efficacy and safety of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the treatment of drug-resistant epilepsy in children.

Clinical data of 71 children with drug-resistant epilepsy admitted to Epilepsy Center, Beijing Children′s Hospital, Capital Medical University from January 2017 to December 2018 was retrospectively analyzed in this study. The patients′ seizure types included focal seizure with or without generalization in 62 cases, focal seizure combined with epileptic spasm in 6 cases, focal seizure combined with myoclonic seizure in 2 cases, and epileptic spasm in 1 case. The MRI manifestations included malformation of cortical development in 27 cases, hippocampal sclerosis in 9 cases, developmental or low-grade tumors in 8 cases, encephalomalacia in 5 cases, dual lesions in 5 cases, and MRI negative in 17 cases. All 71 cases underwent SEEG-guided RF-TC and were followed up by outpatient visit and telephone in order to evaluate the patients′ outcomes. The influencing factors of surgical outcomes were explored by using univariate logistic regression.

Among the 71 patients, 5-14 intracranial electrodes were implanted per case. Transient neurological impairment occurred in 8 cases after operation. There were 69 patients who were followed up for 1.2±0.5 years (0.5-2.5 years) and 2 cases lost to follow-up. Seizure free was achieved in 45 cases (65.2%) at the last follow-up and 18 cases(26.1%) reported a reduction of more than 50% in seizure frequency. Among the 42 cases followed up for >1 year post operation, 25 cases (59.5%) were seizure free. Two cases with periventricular nodular heterotopia were seizure free over 1 year post operation. The cases with focal cortical dysplasia had a seizure-free rate of 85.7% (18/21). Univariate logistic regression analysis showed that the therapeutic effect was related to the purpose (design) of electrode implantation ( P=0.007), while it was not related to the age of operation, duration of illness, seizure type or negative findings on MRI(all P>0.05).

SEEG-guided RF-TC is a safe and effective therapeutic method for drug-resistant epilepsy in children. It is favorable for small or deep lesions and could help explore the epileptic network of patients with negative MRI findings. SEEG-guided RF-TC provides a surgical opportunity for patients with multiple lesions or involving the eloquent cortex, which may be also helpful for making plans and predicting prognosis of resection surgery.

To explore the surgical techniques and clinical outcomes of corpus callosotomy through longitudinal fissure-cavum septum pellucidum et Vergae (L-C) approach for medically intractable epilepsy.

A retrospective study was performed of 23 patients with medically intractable epilepsy who underwent corpus callosotomy at Department of Functional Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, from January 2014 to January 2019. All patients underwent small trapezoid-shaped craniotomy, anterior two thirds corpus callosotomy or one-stage entire corpus callosotomy through L-C approach. Preoperative magnetic resonance venography (MRV) and three-dimensional reconstruction of images were used to assist in the design of incisions and bone windows. Radiographic follow-up was performed regularly after surgery, and the therapeutic effect was evaluated based on the outcome classification standard of corpus callosotomy proposed by Oguni et al. from Montreal Neurological Institute and Hospital, Canada.

Twenty-three patients successfully underwent corpus callosotomy. Among those, 11 patients underwent anterior two thirds corpus callosotomy and 12 underwent one-stage entire corpus callosotomy. Of the 23 patients, 22 underwent corpus callosotomy through the L-C approach, and the approach of corpus callosotomy was switched to trans-lateral-ventricular approach in the remaining 1 case due to its brain developmental abnormality observed during operation, which was a lack of septum pellucidum. There was no intracranial hemorrhage, hydrocephalus or infection after operation, and there was no long-term neurological deficits or complications. Re-examination of MRI or diffusion tensor imaging (DTI) confirmed that the range of corpus callosotomy met the requirements. All patients were followed up for a median of 1.8 years (0.5-5.2 years). Postoperative therapeutic effects were classified as follows: 4 cases of grade A, 6 cases of grade B, 6 cases of grade C, 7 cases of grade D, and 0 case of grade E. The total effective rate was 69.6% (16/23).

The corpus callosotomy through the L-C approach can maintain a central surgical path, thereby reducing the incidence of side injuries and complications, and improving the efficacy of the operation.

To compare the outcome and safety of different early programming regimens of vagus nerve stimulation (VNS) to determine the optimal VNS programming regimen for the treatment of pediatric drug-resistant epilepsy.

The clinical data of 54 children with intractable epilepsy treated with VNS from August 2016 to December 2018 at Department of Neurosurgery, Children′s Hospital Affiliated to Capital Institute of Pediatrics were analyzed retrospectively. According to the stimulation current intensity of post-operative programming regimen, the patients were divided into low-parameter group (≤ 1 mA, 28 cases) and high-parameter group (>1 mA, 26 cases). After 6 months of clinical follow-up, the effective rate of treatment and the incidence of treatment-related complications were compared between the two groups.

Six months after VNS treatment, the rate of seizure free in 54 cases was 13.0% (7/54), and the overall effective rate was 66.7% (36/54). The effective rate of low-parameter group (82.1%, 23/28) was higher than that of high-parameter group (50.0%, 13/26). The difference between the two groups was statistically significant (χ²=6.268, P=0.012). The overall incidence of complications was 7.4% (4/54). There was no significant difference in the incidence of complications between the two groups [0% vs. 15.4% (4/26), χ²=4.652, P=0.102].

VNS seems to be an effective treatment for pediatric drug-resistant epilepsy. Children may benefit more from low-parameter programming than high-parameter programming in the early stage of VNS.

To observe the therapeutic effect of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) involving different branches, and to analyze the relevant factors affecting the outcomes.

The clinical data of 200 patients with TN who underwent MVD at Department of Neurosurgery, Xiangya Hospital, Central South University from January 2017 to September 2018 were retrospectively analyzed. Among them, the first branch of the trigeminal nerve (V1) was involved in 7 cases, the second branch (V2) in 23, the third branch (V3) in 27, V1&2 in 29, V2&3 in 64, and V1-3 in 50. At 1 month, 3 months, and 1 year post operation, BNI (Barrow Neurological Institute) pain intensity scoring criteria were used to assess pain relief and related factors affecting the rate of pain relief were analyzed.

Among all 200 patients, the pain relief rates at 1 month, 3 months, and 1 year post surgery were 91.5% (183 cases), 83.0% (166 cases), and 67.0% (134 cases) respectively. In 166 patients with branch involvement of V2, the pain relief rates at 1 month, 3 months, and 1 year post surgery were 89.8% (149 cases), 81.3% (135 cases), and 64.5% (107 cases) respectively; the remaining 34 cases whose pain symptoms were not related to V2 had the pain relief rates of 100.0% (34 cases), 91.2% (31 cases), and 79.4% (27 cases) respectively. The difference in pain relief rate between the two groups was statistically significant at 1 year post operation (P=0.012). Multivariate logistic regression analysis showed that the branch involvement of V2 was the independent influencing factors of pain relief post MVD in patients with TN (OR=0.688, 95% CI: 0.474-0.996, P=0.048).

The pain relief rate of TN patients with involvement of V2 seems lower than that of TN patients without V2 involvement.

To investigate the accuracy and safety of ROSA robot-assisted SEEG electrode implantation under local anesthesia.

The clinical data of 47 patients with drug-resistant epilepsy who underwent SEEG surgery at Department of Neurosurgery, General Hospital of the Northern Theater Command from November 2016 to November 2018 were retrospectively analyzed in this study. The patients were divided into local anesthesia group (37 cases) and general anesthesia group (10 cases) according to the anesthesia methods of operation. Within 6 hours post operation, the 2 groups of patients underwent three-dimensional head reconstruction CT to decide whether intracranial hemorrhage and other complications occurred. The CT data were imported into ROSA workstation through the PACS (picture archiving and communication system) to accurately measure the transverse deviation between the actual implanted electrode and the planned trajectory.

In the local anesthesia group, a total of 37 patients underwent 41 operations of electrode implantation (4 operations of supplementary electrode implantation), and a total of 353 electrodes were implanted. In the general anesthesia group, 10 patients underwent 12 operations of electrode implantation (including 1 operation of supplementary electrode implantation and 1 re-implantation of electrode at half a year post radiofrequency thermocoagulation) with a total of 90 electrodes implanted. The electrode entry deviation in the local anesthesia group was 1.24±0.77 mm, and the target deviation was 1.71±0.96 mm. The electrode entry deviation in the general anesthesia group was 1.20±0.67 mm and the target deviation was 1.64±0.85 mm, and there was no significant difference between the 2 groups (both P>0.05). In the local anesthesia group, 1 patient (2.7%) developed asymptomatic intracranial bleeding when the electrode was removed, and the hematoma was absorbed itself without causing neurological deficits. There was no intracranial bleeding in the general anesthesia group. No complications such as infection and electrode fracture occurred in either group.

There was no significant difference in electrode accuracy or safety between ROSA-assisted SEEG electrode implantation under local anesthesia and that under general anesthesia.

To investigate the efficacy of microsurgical decompression of peripheral nerves for treatment of dialysis-related peripheral neuropathy (DRPN) of upper limbs.

The clinical data of 15 patients with DRPN of upper extremity admitted to Department of Neurosurgery, China-Japan Friendship Hospital from January to December 2017 were analyzed retrospectively. There were 22 upper limbs of 15 patients with symptoms, among which 2 were treated with median nerve decompression alone and 20 with median nerve and ulnar nerve decompression. After discharge, all patients underwent follow-up at outpatient department, which included reexamination of electromyogram, and inquiry of improvement of numbness and pain symptoms to evaluate the outcome of operations.

The operation was successful in all 15 cases. Six incisions of patients had poor healing, which improved after conservative treatment. The follow-up duration of 15 patients was 12.0±4.5 months (6.0-20.0 months). The results showed that the conduction velocity of sensory branch of median nerve was increased compared with that before operation (46.3 ± 3.1 m/s vs. 37.5±1.8 m/s, P<0.05); the amplitude of action potential was increased compared with that before operation (9.2±1.6 mVvs. 7.7±1.1 mV, P<0.05); the conduction velocity of motor branch was increased compared with that before operation (47.7±2.8 m/svs. 37.8±2.4 m/s, P<0.05); the amplitude of action potential was increased compared with that before operation (10.1±1.9 mVvs. 7.7±1.6 mV, P<0.05). The conduction velocity of sensory branch of ulnar nerve was increased compared with that before operation (45.0±3.6 m/svs. 36.4±2.9 m/s, P<0.05); the amplitude of action potential was increased compared with that before operation (9.2±2.1 mvvs. 6.9±1.2 mv, P<0.05); the conduction velocity of motor branch was increased compared with that before operation (45.8± 3.2 m/svs. 40.1±1.6 m/s, P<0.05); the amplitude of action potential was increased compared with that before operation (8.6±2.5 mVvs. 6.2±1.3 mV, P<0.05). At the latest follow-up, pain symptoms of the 15 patients were relieved in 22 sides (22/22), and numbness in 16 sides (16/22) and motor dysfunction in 18 sides (18/18) were improved.

This study has preliminarily suggested that micro-decompression of peripheral nerves is an effective method for the treatment of DRPN in the upper extremity, and the keys to ensure the therapetuic effect include certain established preoperative diagnosis and complete nerve decompression during operation.

To investigate the clinical risk factors for seizures after cranioplasty in patients with skull defects.

A retrospective study was conducted on the clinical data of 1 064 patients with skull defects who underwent cranioplasty at Department of Neurosurgery, the 988^th Hospital of PLA from January 1996 to September 2018. All patients underwent clinical follow up and were divided into epilepsy group (155 cases) and non-epilepsy group (909 cases) based on whether they had seizures. Univariate and multivariate logistic regression analyses were applied to investigate the clinical risk factors for seizures post cranioplasty in patients with skull defects.

All patients underwent successful cranioplasty and were followed up for the duration of 3-120 months with an average of 13.0±9.6 months. There were 155 patients (14.6%) developing seizures after cranioplasty. Univariate analysis showed that the skull defect time, cause, position, side, area, failure to repair the dura mater during decompressive craniectomy and opening the dura mater during cranioplasty were clinical factors for seizures post cranioplasty in patients with skull defects (all P<0.05). Further multivariate analysis showed that failure to repair the dura mater during decompressive craniectomy (OR=8.523, 95% CI: 1.081-23.394, P<0.001), opening the dura mater during cranioplasty (OR=7.763, 95% CI: 2.582-22.769, P<0.001) and skull repair time more than 6 months (OR=2.874, 95% CI: 2.671-12.972, P=0.027) were independent risk factors for seizures post cranioplasty in patients with skull defects.

Failure to repair the dura mater during decompressive craniectomy, opening the dura mater during cranioplasty and skull repair time more than 6 months can increase incidence of seizures after cranioplasty in patients with skull defects.

To investigate the effect and safety of anterior cervical discectomy and fusion (ACDF) using exoscope in the treatment of cervical spondylopathy.

From March 2017 to March 2019, 15 patients with cervical spondylopathy were admitted to Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University underwent ACDF using exoscope whose data were retrospectively analyzed. Odom scale and Japanese Orthopaedic Association (JOA) scale were used after operation to evaluate the effect of ACDF using exoscope.

All 15 patients successfully underwent the surgeries. The operation time was 100±6 mins (80-160 mins). The bleeding volume was 75±10 ml (40-150 ml). The disc fusion ratio was 19/19.One patient had transient postoperative hoarseness and there was no death post operation. Fifteen patients were followed up for 3-27 months with an average of 11.3±1.7 months. The assessment result based on the Odom scale showed that 12 patients were very satisfied with the operation and 3 patients were satisfied with the operation. The mean JOA score of 15 patients was 15.8±0.2 points at 3 months post operation, which was higher than that prior to operation (13.3±0.4 points) (t=5.8, P<0.01). The symptoms of all patients were relieved and the spinal cord function was improved significantly.

The efficacy of ACDF using exoscope in the treatment of cervical spondylopathy seems good with few complications, which is worthy of being widely used.

To investigate the drift of conus medullaris in patients with simple tethered cord syndrome after transection of filum terminale, and to analyze the relationship between the drift of conus medullaris and lumbosacral sagittal alignment and its significance.

Clinical data of 20 patients with tethered cord syndrome admitted to Neurosurgery Department of Peking University Third Hospital from January 2014 to June 2019 were analyzed retrospectively. Lumbosacral angle (LSA), lumbar lordosis angle (LLA), lumbosacral disc angle (LSDA) were measured in all patients′ lumbosacral sagittal MRI before and after operation to evaluate the lumbosacral sagittal alignment. Bending angle (BA) was defined as the acute angle between the longitudinal axis of the conus medullaris and the longitudinal axis of the lumbar spinal cord. The change of BA (△BA) before and after operation was defined as the drift of conus medullaris. The differences of LSA, LLA, LSDA before and after surgery were compared. Pearson correlation was used to analyze the relationship among the △BA, LSA, LLA and LSDA.

The preoperative LSA, LLA and LSDA of 20 patients were 69.3°±7.4°, 30.0°±9.5°, 12.0°±4.5°, and the postoperative LSA, LLA, LSDA were 69.8°±7.0°, 30.3°±9.1°, 11.9°±4.5° respectively. There were no significant differences between the preoperative and postoperative angles (all P>0.05). BA was decreased from preoperative 22.3°±6.8° to 20.1°±6.7° after operation (t=9.353, P<0.001). Preoperative LSA of 20 patients was positively correlated with LLA (r=0.576, P<0.01). The △BA was 2.3°±1.1°, which was negatively correlated with preoperative LSA (r=-0.610, P<0.01) and highly negatively correlated with preoperative LLA (r=-0.812, P<0.01).

To some extent, the drift of conus medullaris could reflect the release of tethered cord after transection of filum terminale in patients with single tethered cord syndrome. Lumbosacral sagittal alignment may affect the drift of conus medullaris, which is helpful for preoperative judgment of the release degree.

To evaluate the efficacy and influencing factors of dorsal root entry zonectomy (DREZ) in the treatment of neuropathic pain post brachial plexus injury.

A retrospective analysis was conducted on the clinical data of 105 patients with neuropathic pain post brachial plexus injury admitted to Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University from August 2005 to January 2018. According to the corresponding dermatomes of the patient′s pain and sensory loss area, the operation of cervical DREZ was performed. After surgery, all patients were interviewed by telephone or outpatient clinic and followed up based on the pain numerical rating scale (NRS). The patient′s efficacy was assessed with a pain improvement rate [(preoperative NRS-postoperative NRS) / preoperative NRS × 100%]: the improvement rate of >75% as excellent, 50%-75% as good, and ≤50% as poor. Further univariate and multivariate logistic regression analysis were used to determine the relevant factors affecting the efficacy of patients.

The operations of all 105 patients were successful. Postoperative complications included 33 cases (31.4%) of numbness, 20 cases (19.0%) of deep sensory disturbance, 9 cases (8.6%) of muscle weakness in ipsilateral lower limb, 5 cases (4.8%) of numbness in contralateral limb and 1 case (1.0%) of postoperative dural leakage. There was no poor wound healing or infection. The follow-up duration of 105 patients was 47.3 ± 25.5 months (10-144 months). By the last follow-up, the median improvement rate (upper and lower quartiles) in 105 patients was 100% (60%, 100%). Among them, the outcome was excellent in 74 (70.5%) cases, good in 9 (8.6%) and poor in 22 (20.9%). The results of univariate analysis showed that sex, age, cause of injury, time of occurrence of pain after injury, form and nature of pain, number of dermatomes involved and postoperative complications had no effect on the therapeutic effect (all P>0.05), while the course of disease and the degree of spinal cord atrophy had influence on the outcome (bothP<0.05). Further multivariate analysis showed that the mild degree of spinal cord atrophy was an independent protective factor affecting the efficacy of patients (OR=95.952, 95% CI: 4.171-2 207.414, P=0.004).

DREZ demonstrates long-lasting effect in the treatment of neuropathic pain following brachial plexus injury, and the patients with mild cervical spinal cord atrophy before operation may have favorable surgical effect.

To investigate the effect of cord/sac ratio on postoperative long-term retethering of complex spinal lipomas in children.

The clinical data of 56 children with complex spinal lipomas treated at Department of Neurosurgery, Shenzhen Children′s Hospital from January 2009 to June 2014 were analyzed retrospectively. The surgical operations of microsurgical resection of lipoma + reconstruction of basal plate + plasty of dural sac under electrophysiological monitoring were performed. The cord/sac ratio was evaluated on postoperative MRI, and the effect of cord/sac ratio on postoperative long-term spinal cord retethering was analyzed.

All 56 children underwent successful operation. Postoperative MRI indicated that the cord/sac ratio was <30% in 10 cases, 30% to 50% in 31 cases, and >50% in 15 cases. No serious postoperative complications occurred. Postoperative follow-up was performed in 52 cases, with a median follow-up period of 8.9 years (5.0 to 10.5 years). There were 6 cases (11.5%, 6/52) of spinal cord retethering which required re-operation (retethered group). Among those, the postoperative cord/sac ratio was 30-50% in 2 cases and >50% in 4 cases. In the non-retethering group, the cord/sac ratio was <30% in 10 cases, 30-50% in 27 cases, and >50% in 9 cases. There was significant differences in cord/sac ratio between the two groups ( P=0.039).

The cord/sac ratio is the most important prognostic factor affecting the probability of postoperative retethering of complex spinal lipoma. Smaller cord/sac ratio is associated with lower probability of retethering.

To investigate the safety and efficacy of Willis covered stent (WCS) in the treatment of traumatic pseudoaneurysm of intracranial segment of internal carotid artery (ICA).

A retrospective study was conducted on the clinical data of 15 patients with traumatic pseudoaneurysm of intracranial segment of ICA who were admitted to Department of Neurosurgery, General Hospital of PLA Central Theater Command from December 2013 to May 2019. WCS was selected based on the diameter of the parent artery and length of the involved vessels. Postoperative Dyna-CT reexamination and stent reconstruction were performed routinely in all patients. All patients were followed up after discharge and digital subtraction angiography (DSA) reexamination was performed to determine the recurrence of aneurysm. MRS (modified Rankin scale) score was also performed to assess the patient′s recovery.

Among the 15 patients, 12 were successfully implanted with WCS at one time and the remaining 3 had "internal leakage" after WCS implantation. Among the 3 cases, 1 underwent balloon dilation and the " internal leakage" disappeared, and the remaining 2 underwent postoperative auxiliary compression on the ipsilateral carotid artery. Immediately after the operation, DSA showed that all patients had successful vascular reconstruction and pseudoaneurysms disappeared. One patient died of severe craniocerebral trauma after surgery, while the other 14 patients had no new cerebral infarction or cerebral hemorrhage revealed by postoperative Dyna-CT. No surgical-related complications occurred in this series. The follow-up duration of 14 patients was 5.4±1.6 months (3.0-8.0 months). At 3 months post operation, the mRS scores of 14 patients were 1-2 points in 10 cases and 3 points in 4. The aneurysms of 12 patients were followed up with DSA, and no recurrence was discovered at the last follow-up, Two patients of "internal leakage" were followed up at 4 months after operation, the "internal leakage" disappeared.

WCS seems safe and effective in the treatment of traumatic pseudoaneurysms in the intracranial segment of ICA and may be one of the ideal materials for that treatment.

To explore the efficiency and safety of endovascular therapy of spinal dural arteriovenous fistulae (SDAVF) using pressure cooker technique (PCT).

Six patients with SDAVF were treated with PCT at Department of Neurosurgery, Changhai Hospital Affiliated to Navy Medical University from February 2017 to September 2018 and retrospectively reviewed in this study. The PCT was applied to embolization in all cases. The reflux did not exceed the plug in 4 cases when Onyx was used for embolization. Microsurgery was performed in 1 case because of incomplete embolization. Digital subtraction angiography (DSA) was performed immediately post operation to assess the embolization. All patients were followed up by outpatient clinic or telephone. Aminoff-Logue score was determined to assess the spinal cord function. Follow-up MRI of the spinal cord was performed to evaluation the embolization.

All 6 patients underwent successful operations. DSA examination immediately post operation showed that 5 cases had complete embolization and 1 case had residual fistula. No permanent neurological complications occurred in this series. In 1 case, intraoperative angiography showed intercostal artery dissection, and the proximal intercostal artery was occluded with a spring coil. Postoperative CT examination of the thoracic vertebra showed the formation of intra-costal muscle hematoma. The continuous back pain after operation was relieved on the third day. Among the 6 patients, 5 were followed up at outpatient clinic and 1 was followed up by telephone. The median follow-up duration was 5.5 months(4.0-22.0 months). At 3 months post surgery, the Aminoff-Logue score of all 6 patients were decreased compared with those before surgery (2.0±0.7 vs. 4.0±1.5, P<0.05). Spinal cord function was significantly improved. There was no related complication at 6-month follow-up post operation in 1 patient who had the tube retained due to difficulty in tube withdrawal. One patient underwent microsurgery and DSA at 10-month follow-up post surgery revealed no fistula imaging.

It has been preliminary suggested that endovascular treatment using PCT seems safe and effective for SDAVF.

The disease characteristics and postoperative survival of asymptomatic World Health Organization (WHO) gradeⅡgliomas were analyzed.

The clinical data of 271 patients with WHO grade Ⅱ gliomas treated by neurosurgery in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2016 were analyzed retrospectively. They were divided into the asymptomatic group (34 cases) and the symptomatic group (237 cases). The differences of disease characteristics and prognosis between the two groups were analyzed. Multivariate Cox regression was used to analyze the risk factors for prognosis.

Compared with the symptomatic group, the proportion of tumor invading functional area in the asymptomatic group was lower [58.2%(138/237) vs. 38.2%(13/34), P=0.041], but there was no significant difference between the two groups in age, gender, histological type, Ki67, mutation of isocitrate dehydrogenase (IDH) and telomerase reverse transcriptase promoter (TERTp), codeletion of 1p/19q (P>0.05). The total resection rate of tumor was 94.1% (32/34) and 78.5% (186/237) respectively. The radiotherapy rate was 97.1% (33/34) and 78.5% (186/237) respectively. The difference was statistically significant (P<0.05). All patients were followed up for 1.1-86.0 months(median: 43.0 months). The recurrence rates of the asymptomatic group and the symptomatic group were 8.8% (3/34) and 27.4% (65/237) respectively. The median survival time was 45.5 (28.5-80.0) months and 43.0 (1.1-86.0) months respectively. The difference was statistically significant (P<0.05). Kaplan Meier survival analysis showed that the overall survival rate and progression free survival rate of asymptomatic group were significantly higher than those of symptomatic group (P<0.05). Multivariate Cox regression analysis showed that invasion of functional areas (HR=2.048, 95%CI: 1.017-4.125, P=0.045) and recurrence (HR=0.009, 95%CI: 0.002-0.038, P<0.001) were independent risk factors for postoperative survival. The presence or absence of symptoms was not an independent factor for postoperative survival (HR=1.570, 95%CI: 0.200~12.346, P=0.668).

Compared with patients with symptomatic low-grade gliomas, the incidence of functional area tumors and postoperative recurrence rate in asymptomatic patients were lower. There was no significant difference in pathological features, but the survival period of asymptomatic patients was longer.

To analyze the expression patterns of P2X7 receptor (P2X7R) and neuroligin (NLGN) within 24 hours after seizures and to explore the possible mechanism of P2X7R inhibitors in negative regulation of epileptogenesis.

Healthy male Sprague Dawley (SD) rats were divided into 6 groups using the random number table, which were 1 h, 3 h, 6 h, 12 h, and 24 h groups and a control group with each group containing 3 rats. Except the control group, the other groups of rats were administered with lithium chloride-pilocarpine to establish the epilepsy model, which was considered as successful in case of grade 4 or 5 based on Racine scale. Those rats were sacrificed at 1 h, 3 h, 6 h, 12 h, and 24 h post seizures. Rats in control and 1 h groups were sacrificed at the same time. Protein immunoprinting was used to detect expression of P2X7R, NLGN1 and NLGN2 in the hippocampus and entorhinal cortex in each group of rats. Using the random number table, healthy male SD rats were further divided into an intervention group (intraperitoneal injection of P2X7R inhibitor + vehicle) and a control group (intraperitoneal injection of equivalent dose of saline + vehicle) with 3 rats in each group. The latency of drug-induced epilepsy in two groups of rats was documented to determine the effect on epileptogenesis, and then the expression of NLGN1 and NLGN2 in the hippocampus and entorhinal cortex was detected by protein immunoprinting to determine the effect of P2X7R inhibitors on their expression.

Epileptic rat models were successfully made in the 1 h, 3 h, 6 h, 12 h, and 24 h groups. Protein immunoprinting results showed that the relative expression levels of P2X7R, NLGN1 and NLGN2 after the seizure 1 hour or 3 hours(hippocampus: 1.194±0.053, 2.367±0.336, 2.319±0.234; entorhinal cortex: 1.185± 0.104, 2.094±0.178, 1.512±0.332) were significantly higher than those in the control group (hippocampus: 1.014±0.046, 1.108±0.101, 1.134±0.177; entorhinal cortex: 0.917±0.081, 1.046±0.093, 1.017±0.028; all P<0.05). With the increase of seizure duration, the protein expression showed a tendency of decrease (P<0.001). The latency of drug-induced epilepsy in the intervention group was significantly longer than that of control group (34.5±2.6 minvs. 20.0±3.1 min, P=0.029). Protein immunoprinting showed that the relative expression levels of NLGN1 and NLGN2 in the hippocampus of the intervention group (0.678±0.011 and 0.904±0.060 respectively) were lower than those of the control group (1.031±0.039 and 1.135±0.079 respectively, both P<0.05), while the relative expression levels of NLGN1 and NLGN2 in the entorhinal cortex of the intervention group were not statistically different from those of the control group (bothP>0.05).

After the seizure 1 hour or 3 hours, the expression of P2X7R and NLGN proteins in both the hippocampus and entorhinal cortex increases significantly, and decreases with the duration of seizures within 24 h, and P2X7R inhibitors could suppress epileptogenesis by inhibiting the expression of NLGN in the hippocampus.