Volume 36 · Issue 07 · 2020

To investigate the relationship between the position of active contacts of deep brain stimulation targeting bilateral subthalamic nucleus (STN-DBS) and its clinical effects on motor symptoms in Parkinson′s disease (PD) patients.

We retrospectively analyzed the clinical data of 57 patients with PD admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (49 cases), Department of Neurosurgery, the First Hospital of Hebei Medical University (3 cases), and Department of Neurosurgery, General Hospital of Ningxia Medical University (5 cases) from March 2018 to December 2018. All patients underwent bilateral STN-DBS. Unified Parkinson′s disease rating scale-part Ⅲ (UPDRS-Ⅲ) scores, levodopa equivalent daily dose (LEDD), Parkinson′s disease questionnaire-39 (PDQ-39) scores before operation and within 6 months after operation were determined. The location of active contacts and volume of tissue activated (VTA) in the Montreal Neurological Institute (MNI) space, and their correlation with the rate of improvement of motor symptoms (UPDRS-Ⅲ score improvement rate) were examined.

At 6 months post operation, the UPDRS-Ⅲ scores of 57 patients (Med-off) were improved by 55.4±18.9 % (P<0.001) compared with that before operation. The improvement rate of PDQ-39 score (47.4%±23.2%,P<0.01) and the reduction rate of LEDD (40.1%±24.3%,P<0.01) at 6 months post surgery were positively correlated with the improvement rate of motor symptoms (Med-off) (PDQ-39:r=0.461, P<0.001; LEDD:r=0.354, P=0.007). The rate of improvement of UPDRS Ⅲ (Med-off) and the Z-axis coordinate of the active contacts in the MNI space were positively correlated (left side: r=0.349, P=0.008; right side: r=0.369, P=0.005). In the MNI space, there was no correlation between the UPDRS-Ⅲ score improvement rate (Med-off) at 6 months after operation and bilateral VTA in the STN motor subregion, STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients (all P>0.05). At 6 months after surgery, the differences between the Z-axis coordinate in the different improvement rate subgroups (<25%, 25%-50%, and >50%) in the MNI space were statistically significant (left side:P=0.030; right side: P=0.024). In the MNI space, there were no statistically significant differences between the 3 groups in the VTA of the active electrode contacts (all P>0.05).

STN-DBS could improve the motor symptoms of PD patients and their quality of life. The closer the active contact is to the dorsolateral sensorimotor area of STN, the better effect the DBS has on the motor symptoms of PD patients.

To investigate the clinical efficacy of deep brain stimulation (DBS) in the treatment of different types of segmental craniocervical dystonia (SCCD).

Clinical data of 80 patients with SCCD admitted to Department of Neurosurgery of China-Japan Friendship Hospital from March 2015 to September 2018 were retrospectively analyzed. There were 33 cases (41.2%) with blepharospasm as the main manifestation. There were 35 cases (43.8%) of blepharospasm with oromandibular dystonia. In addition, there were 12 cases (15.0%) with cervical symptoms and other symptoms, including 8 cases with the comorbidity of spasmodic torticollis and 4 cases with the comorbidity of dysarthria. All patients underwent bilateral GPi (globus pallidus interna)-DBS. During the clinical follow-up, Burke- Fahn-Marsden Dystonia Rating Scale (movement part) (BFMDRS-M) was used for preoperative and postoperative comparison to analyze the surgical efficacy of GPi-DBS for SCCD with different manifestations.

Out the 80 patients, 30 were lost to follow-up and 50 were followed up for 24.5±12.2 months (4-47 months). The total effective rate of GPi-DBS for SCCD was 68.0% (34/50) at the latest follow-up. In this series, the effective rate in patients with blepharospasm as the main manifestation was 65.0% (13/20) and 68.0% (17/25) in those with blepharospasm combined with oromandibular dystonia. In addition, the effective rate of patients with the comorbidity of cervical symptoms or other symptoms was 4/5. The BFMDRS-M scores of 50 patients before and after surgery showed statistically significant differences (6.3±2.2 point and 4.9±2.5 point, respectively, P<0.001), and the preoperative and postoperative BFMDRS-M scores of patients with different manifestations showed statistically significant differences (allP<0.05). During the follow-up, except for 1 case with implant rejection and skin erosion, the remaining 49 patients had no surgical or hardware-related complications.

GPi-DBS, with few complications, is an effective treatment for various clinical manifestations of SCCD.

To explore the application of new MRI sequence images in the diagnosis and treatment of drug-refractory orbitofrontal(OF) epilepsy.

We retrospectively included four consecutive patients with drug-refractory orbitofrontal epilepsy proven by SEEG between January 2016 and August 2018 at epilepsy center of Yuquan Hospital, Tsinghua University. Patients were analyzed in terms of their conventional sequence images (T1W and FLAIR), new sequence images (DIR, FLAWS), MRI image post-processing(MAP), and interictal PET image.

Interictal epileptiform discharges were found over frontal and temporal deviations in all 4 patients on surface EEG; in three, the lateralization of interictal discharges was consistent with the surgical site side. The conventional MRI in this group were regarded as all negative. Three of the four patients had a MAP⁺ abnormalities in the OF region after post-processing of T1 data. Among the 3 cases with DIR and FLAWS sequences, single lesion was found in the OF area in 2 cases, showing the blurred junction of the gray-white matter and the abnormal signal intensity of subcortical whiter matter in the OF area. Focal hypometabolic regions in the OF region were found in three of four patients. Three patients underwent SEEG-guided radiofrequency thermocoagulation in orbitofrontal cortex. After SEEG investigation, one patient underwent resective neurosurgery twice. The operations of all 4 patients were successful and no permanent neurological deficits occurred after operation. The postoperative follow-up time was 7, 13, 14, and 18 months, respectively, and there were no seizures. Among them, the Engle classification of 3 cases with follow-up time> 12 months was all grade Ⅰ.

The patients with OF epilepsy are often conventional MRI negative. New sequences (DIR and FLAWS) have a higher positive rate than traditional MRI sequences. MRI post-processing technology MAP and interictal PET can assist in the localization of lesions. The combination of multiple imaging techniques can improve the efficiency of preoperative assessment of OF epilepsy.

To conduct a preliminary study of the cognitive function of adult patients with Moyamoya disease (MMD).

We prospectively enrolled 36 adult MMD patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from December 2018 to April 2019 and 22 healthy controls (HC) matched with gender, age and education level who underwent health examination during the same period. Both groups underwent the assessment of cognitive function based on the examinations including intelligence quotient (IQ), prospective memory (PM), Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Stroop test, Trail Making Test A (TMT-A), Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT). When abnormal performance in 3 or more neuropsychological tests was observed, cognitive impairment was considered. According to the comparison of Suzuki stage (SS) in the left and right cerebral hemispheres, adult patients with MMD were divided into the subgroup with SS in the right side > SS in the left side (9 cases) and the subgroup with SS in left side ≥ SS in the right side (27 cases), and the cognitive function was compared between the 2 subgroups.

Out of 36 cases, 10 (28%) was diagnosed with cognitive impairment. Compared with HC, adult MMD patients had a comprehensive cognitive function impairment, including IQ, PM, verbal function (VF), attention, retrospective memory (RM) and executive function (EF) (all P<0.05). Through covariance analysis of IQ, significant differences were revealed in scores of time-based prospective memory (TBPM), PM and attention between HC and adult MMD patients (allP<0.05). Specifically, the cognitive scores of TBPM were 12.4±2.8 and 9.4±3.9, those of PM were 26.5±3.9 and 21.4±6.5 those of RBANS (in attention dimension) were 108.6±9.2 and 95.6±15.0 in HC and adult MMD groups respectively. In contrast, scores of retrospective memory (RM), called as delayed memory in the RBANS test, of MMD and HC groups were 90.7±9.9 and 82.5±14.4 respectively, which had no significant difference (P>0.05). Compared with the right side SS > the left side SS subgroup, the left side SS ≥ the right side SS subgroup had worse cognitive performance, which was indicated by lower scores of block design (BD) in Wechsler Adult Intelligence Test, longer time consumption on word and color interference in Stroop test, more visual omissions and longer visual response time in CPT, longer time consumption on dot symbol and more errors in TMT-A (allP<0.05).

MMD patients have a wide range of cognitive impairments, with significant impairment of memory and attention function. Impaired left brain hemispheres are more likely to trigger cognitive impairment.

To explore the application value of functional magnetic resonance imaging (fMRI) combined with intraoperative neuroelectrophysiological technique in the localization of motor area of intractable epilepsy patients.

The clinical data of 9 patients with intractable epilepsy who underwent epileptogenic zonectomy at Epilepsy Center of Yuquan Hospital, Tsinghua University from June 2018 to April 2019 were retrospectively analyzed. The median age was 15 years old (range: 2-31 years old). All patients underwent head MRI, diffusion tensor imaging (DTI) and blood oxygen level depend (BOLD)-fMRI before operation, and the lesion and motor functional area were initially located. During the operation, neuroelectrophysiological monitoring of motor evoked potential (MEP) was used to confirm the motor functional area, and surgical navigation system was employed to identify the lesion area and functional area. Neuroelectrophysiological monitoring should be performed during the same time period when the lesion is removed to preserve the functional area and remove the lesion to the greatest extent. CT examination was performed after operation to detect the edema and hemorrhage. We compared the muscle strength of the patients before operation, after operation and at 3 months of follow-up, which served as an evaluation index of the outcome of motor area preservation.

The DTI results of 9 patients clearly showed the lesion, the motor fiber connection between the lesion and the cerebral peduncles. Among the 9 patients, 4 had preoperative BOLD-fMRI results which were consistent with the functional area identified by intraoperative neuroelectrophysiological monitoring of MEP, 1 patient had partially consistent results, and 4 had inconsistent results. The epileptogenic zones in 9 patients were completely removed. Five patients had varying degrees of muscle strength reduction after operation. Those 5 patients had slight brain edema on head CT imaging, which was relieved after 1 week. There was no case of intracranial hemorrhage. At 3-month follow-up, 8 patients had no seizures, only 1 patient still had seizures, and the frequency of seizures was decreased. The muscle strength of 8 patients was the same as before surgery, and the muscle strength of 1 patient was improved compared with preoperative conditions.

Preoperative BOLD-fMRI and DTI combined with intraoperative neuroelectrophysiological technique for motor area identification seem to have a relatively good outcome in terms of motor function preservation in patients with intractable epilepsy.

To evaluate the safety and efficacy of simple balloon dilatation in the treatment of intracranial atherosclerotic stenosis (ICAS).

From November 2018 to June 2019, a total of 78 patients who were diagnosed as ICAS and would undergo simple balloon dilatation at Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University were prospectively enrolled into this study. Residual vascular stenosis rate of no more than 30% following simple balloon dilatation (without rescue measure such as stent placement) was considered as a success. The incidences and mortality rates of symptomatic cerebral infarction and intracranial hemorrhage within 72 hours post operation were investigated. The incidences of stroke in the target vessel area and restenosis of the target vessel within 90 days post surgery (both symptomatic and non-symptomatic) were explored as well.

Balloon dilatation was successfully performed in 78 patients, of whom 65 (83.3%) underwent simple balloon dilatation merely, the other 13 (16.7%) underwent extra stent implantation after balloon dilatation (6 cases for arterial dissection and 7 cases for vessel elastic retraction). Within 72 hours post operations, complications occurred in 2 cases (2.6%), including 1 case of symptomatic cerebral infarction and 1 case of symptomatic cerebral hemorrhage. Of all 78 patients, 22 (28.2%) had dissection of the target vessels after dilatation, 16 (20.5%) underwent no rescue therapy based on good maintenance of forward blood flow, 6 (7.7%) underwent rescue therapy such as stent implantation. Among the 65 patients who were treated with simple balloon dilatation, 1 (1.5%) developed ischemic stroke in the target vessel area within 90 days post operation, and 6 (9.2%) had restenosis, including 2 cases (3.1%) of symptomatic restenosis and 4 cases (6.2%) of asymptomatic restenosis. Among them, 1 case of symptomatic restenosis underwent further stent implantation.Among the 13 patients who were treated with simple balloon dilatation and stent implantation, 4 case (30.8%) had restenosis within 90 days, including 2 cases of symptomatic restenosis and 2 cases of asymptomatic restenosis.

The success rate of simple balloon dilatation for the treatment of ICAS is generally high, the incidence of complications was relatively low and the efficacy seems good. It still needs to be further confirmed by large-sample studies such as randomized controlled trials.

To evaluate the efficacy of synchronous carotid endarterectomy (CEA) combined with coronary artery bypass grafting (CABG) for patients with concomitant severe carotid and coronary stenosis.

The clinical data of 30 patients who underwent CEA + CABG surgeries from September 2014 to September 2019 at Department of Neurosurgery and Department of Cardiac Surgery, Peking University Third Hospital were prospectively analyzed. We documented the perioperative complications and followed up the therapeutic effects in those cases.

Among 30 cases, brain stem infarction occurred perioperatively in 1 patient (3.3%), hoarseness occurred in 1 patient (3.3%) due to the stretching of laryngeal recurrent nerve, and MRI revealed new infarction lesions in 3 patients (10.0%), which were all asymptomatic and completely disappeared after 1-3 months. Twenty-one patients underwent head and neck angiography at 1-3 months post surgery, and no carotid restenosis or coronary artery bridge restenosis was reported. The median follow-up time of 30 patients was 44.7 (6.0-67.2) months. Respiratory failure due to lung infection occurred in 1 patient (3.3%) who died of multiple organ failure after 6 months. Among the remaining 29 survivors, 26 had been followed up for 1 year after surgery, and 25 underwent imaging follow-up showing no restenosis. Twenty-two patients had been followed up for 2 years. One patient was diagnosed as severe in-stent stenosis before synchronous operations, for whom the stent and carotid plaque were removed during CEA. At 18 months post operation, asymptomatic restenosis was reported in that patient who underwent carotid artery stenting (CAS) again, and no obvious stenosis was found at 2-year follow-up. One patient had been followed up for 5 years. No new cardio-cerebral vascular accidents occurred at the end of follow-up. Some patients showed improvement of cardiac function. By the end of the latest follow-up, the patient’s heart function was graded as class Ⅰ in 9 cases, class Ⅱ in 19 cases, and could not be evaluated because of respiratory failure and brain stem infarction in 2 cases.

Synchronous CEA and CABG surgeries are safe and effective for patients with concomitant severe carotid and coronary stenosis.

To explore the clinical application of superselective balloon occlusion test (BOT) in complicated intracranial aneurysms and the safety and feasibility of imaging-based evaluation.

A retrospective study was conducted on the clinical data of 16 patients who underwent superselective BOT for evaluation of intracranial complex aneurysms at Department of Neurosurgery, the First Medical Center of PLA General Hospital (n=15) and Department of Neurointervention, Beijing Anzhen Hospital, Capital Medical University (n=1). Among them, 12 patients had MCA (middle cerebral artery) complex aneurysms, 3 patients had PCA (posterior cerebral artery) aneurysms, and 1 patient had ACA (anterior cerebral artery) aneurysms. The patient′s neurological function was assessed and the delay time of cortical capillary phase was calculated post temporary occlusion of the parent artery based on imaging results. The presence of neural dysfunction was considered as a positive test result. The collaterals were categorized based on the collateral flow grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) by angiography. Surgical plans were chosen based on the test results. The outcomes were evaluated according to the modified Rankin Scale score (mRs).

Among 16 cases, there were no technical complications related to superselective BOT. In this series, 3 cases showed positive results of BOT and the remaining 13 had negative results. After temporary blocking of the parent artery, the delay time of cortical artery indication on imaging in the blood supply area was 0.5-2.5(1.4±0.7)s. In the trial, collateral blood flow was graded as poor in 4 cases (grade 1 or 2, including 2 patients with positive test results), and good in 12 cases (grade 3 or 4). Three test-positive patients underwent aneurysm isolation plus STA-MCA bypass surgery and 1 developed muscle weakness in the left upper limb after surgery. Thirteen test-negative patients underwent endovascular embolization of aneurysm or its parent artery ligation, and 3 patients showed mild neurological dysfunction after surgery. The follow-up duration was 3.0-6.0 (4.6±1.2) months in 16 patients, and the last follow-up of 16 patients revealed a mRS score of 0.

The superselected BOT seems to be an effective way to predict the tolerance of parent artery occlusion. The preliminary experience indicates that it is safe and reliable, which could provide valuable information for clinical treatment options. More cases need to be collected to confirm the objective evaluation index.

To explore the safety and efficacy of endovascular treatment in patients with ruptured middle cerebral artery (MCA) aneurysms.

A retrospective analysis was conducted on the clinical data of 52 patients with ruptured MCA aneurysms admitted to Department of Neurosurgery, Ningxia Medical University General Hospital from January 2010 to December 2018. All 52 patients (total 52 aneurysms) underwent endovascular treatment. Among them, single-microcatheter coiling was performed in 17 cases, double-microcatheter assisted coiling in 14 and stent-assisted coiling in 21. Digital subtraction angiography (DSA) was performed immediately after endovascular treatment. The immediate embolization degree and postoperative DSA follow-up were evaluated by Raymond-Roy occlusion classification. All patients underwent imaging follow-up after discharge. The patient’s outcome was evaluated based on the modified Rankin scale (mRS).

Of the 52 patients with 52 aneurysms, 1 had rupture of aneurysm and turned to craniotomy and clipping of aneurysm, and the remaining 51 underwent successful endovascular therapy. Postoperative grading results of 51 aneurysms based on Raymond-Roy occlusion classification were class Ⅰ in 33 cases, class Ⅱ in 15, and class Ⅲ in 3. One case of stent-assisted coil embolization developed intraoperative stent thrombosis, which had good outcome without sequela following symptomatic treatment. The follow-up time after discharge of 52 patients was 13.4±3.1 months (2 to 48 months), of which 46 cases (88.5%) reported good outcome (mRS: 0-2), and 6 cases (11.5%) had poor outcome (mRS of 3 in 3 cases, mRS of 4 in 2, mRS of 5 in 1). A total of 46 patients were reviewed with DSA, of which 3 relapsed. One case had partial recanalization of the primary aneurysmal sac, underwent a second embolization, and the degree of immediate embolization reached Raymond-Roy class I level. In 1 patient, microcatheter could not be in place during the second embolization, and the aneurysm disappeared after 1 year of observation. One case had residual of aneurysmal neck and showed no change from conditions post the first embolization, it was recommended to continue follow-up observation.

Clinical results and imaging follow-up of endovascular treatment of ruptured MCA aneurysms seem good. However, its safety and efficacy still need to be confirmed by a larger sample size and longer follow-up.

To explore the prognostic factors of adult cerebral glioma and the relationship between tumor resection and survival as well as postoperative seizure control rate.

Based on the Chinese Glioma Genome Atlas (CGGA), a total of 1 828 glioma patients who underwent surgical resection at Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from January 2006 to December 2018 were enrolled in this retrospective study. The clinicopathological information and follow-up data of all patients were collected. All tumors were classified according to the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System. The prognostic factors were identified by univariate and multivariate Cox regression analysis, and the survival differences between different patient subgroups were evaluated by Kaplan-Meier analysis.

The median overall survival periods of WHO grade Ⅲ and Ⅳ glioma patients were 82.43(2.60-164.20)months and 16.47(0.63-143.43)months, respectively. The median progression-free survival periods of WHO grade Ⅲ and Ⅳ glioma patients were 64.73(0.67-156.70)months and 12.13(0.63-143.43)months, respectively. For WHO Ⅱ and Ⅲ gliomas, the survival of patients with isocitrate dehydrogenase (IDH) mutation and chromosomal 1p/19q codeletion was significantly prolonged (P<0.001). For WHO grade Ⅳ gliomas, the survival of patients withIDH mutations was significantly prolonged (P<0.001). Multivariate Cox regression analysis showed that increased age (HR=1.015, 95%CI: 1.006-1.024, P<0.001) was an independent adverse prognostic factor; and gross total tumor resection (HR= 0.220, 95%CI: 0.175-0.277, P<0.001), WHO lower grade (WHO Ⅱvs. Ⅳ: HR=0.142, 95%CI: 0.104-0.192, P<0.001; WHO Ⅲvs. Ⅳ: HR= 0.348, 95%CI: 0.265-0.458, P<0.001),IDH mutation (HR=0.511, 95%CI: 0.400-0.652, P<0.001), chromosome 1p/19q codeletion (HR=0.536, 95%CI: 0.404-0.711, P<0.001) were independent favorable prognostic factors.IDH-mutated tumors were more amenable to surgical resection (all P<0.05). Tumor total resection could significantly prolong the overall survival and progression-free survival (allP<0.001) and improve the seizure-control rate at 12 months after surgery for patients with grade Ⅱ-Ⅳ gliomas (allP<0.01).

Age, WHO grade, the extent of resection, IDH mutation status, and chromosome 1p/19q co-deletion status are prognostic factors for patients with primary cerebral gliomas. Maximal safe resection of the tumor could prolong survival of patients and improve the postoperative seizure control rate.

To comparatively analyze the clinical features of gliosarcoma (GS) and glioblastoma (GBM).

A retrospective analysis was conducted on the clinical data of 12 cases of GS (GS group) and 63 cases of GBM (GBM group) admitted to Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology from April 2011 to September 2018. Both groups of patients underwent craniotomy and microsurgical resection of tumor followed by pathological examination. We compared the general data, imaging and pathological data of the two groups of patients.

The differences in age and gender in both groups were not statistically significant (both P>0.05). The differences between tumor position, tumor volume, enhancement pattern, peritumoral edema and intratumoral liquefactive necrosis in both groups were not statistically significant (allP>0.05), while the incidence of dura invasion in GS group (8/12) was higher than that in GBM group (16/63) (P<0.05). GS histologically displayed a typical glioma component and sarcomatous component. By histochemical staining, the diffuse expression of GFAP (glial fibrillary acidic protein) was similarly detected in both gliomatous component of GS and GBM patients, and reticular fiber staining was specifically found in sarcomatous component of GS. Molecular pathological studies found no difference in isocitrate dehydrogenase 1/2 mutation, 1p heterozygous deletion, 19q heterozygous deletion, 1p/19q combined deletion,ATRX mutations, P53 mutations or EGFR amplification mutations between 2 groups (all P>0.05). Ki-67 index in GS group was 1.5-fold higher than that in GBM group (32.3±14.2%vs. 20.5±9.7 %, P<0.001). Additionally, 75.0% of GS patients harboredTERT promotor mutation, which was higher than that of GBM patients (6/8 vs. 8/37, P<0.05).MGMT promoter methylation was lower in GS group in comparison with that in GBM group (1/8 vs. 20/37, P<0.05). The difference between 2 groups in the extent of tumor resection was not statistically significant (P>0.05).

There seems no significant difference between the imaging manifestations of GS and GBM. However, GS is more likely to invade the dura with higher Ki-67 values and has the sarcomatous component specifically presenting reticular fibers. In addition, GS tends to have TERT promoter mutations as well as a lower ratio of MGMT promoter methylation.

To explore the diagnosis and surgical treatment outcome of pituitary abscess.

The clinical data of 14 cases of pituitary abscess admitted to Department of Neurosurgery, Peking University Third Hospital from September 2000 to September 2019 were analyzed retrospectively in this study. All patients underwent abscess debridement via endonasal transsphenoidal approach. The pus and tissue of pus wall were collected during operation for pathogenic examination, and anti-infection treatment was administered post operation. At 2 weeks after operation, the head MRI and routine blood test were performed. All patients received regular clinical and imaging follow-up to explore the improvement of clinical symptoms and recurrence of abscess.

The main clinical symptoms of 14 patients were headache (13/14), vision decline (10/14), hypopituitarism (8/14), diabetes insipidus (6/14). In this series, 8 patients had the history of infection and 7 of them had sinusitis. The lesions of sellar region or lesions of sellar region and suprasellar region were revealed by both CT and MRI. The central cystic changes were observed on MRI (14/14), and ring enhancement (11/14) or irregular enhancement (3/14) was shown on enhanced MRI. A total of 14 patients were reviewed 2 weeks after operation, and the abscess disappeared. There was no death or infection. A large number of neutrophils, plasma cells, lymphocytes or necrotic tissues were found in the pus smear of 14 patients. Pathogenic bacteria were detected in 3 cases including Gram-positive bacteria in 2 cases and Gram-negative bacteria in 1 case. The follow-up time of 14 patients was 4.5±1.2 months (3-6 months). During follow-up, the body temperatures of all patients were normal. Preoperative headache and declined vision were improved. Out of 8 patients with hypopituitarism, 7 recovered obviously and only 1 patient still underwent drug replacement treatment. Out of 6 patients with diabetes insipidus, 4 recovered completely and the urine volumes of the remaining 2 patients were reduced significantly. At the latest follow-up, no recurrence of abscess was reported based on enhanced MRI of sellar region.

The pituitary abscess is nonspecific in terms of clinical features and thus easy to be misdiagnosed. When the patient has a history of infection, diabetes insipidus or hypopituitarism, and medical imaging suggests that there is cystic lesion in the sellar area, the possibility of pituitary abscess should be considered. The outcome of pituitary abscess seems good following endonasal transsphenoidal operation and reasonable postoperative anti-infection treatment.

To explore the clinical efficacy of endoscopic endonasal surgery combined with microsurgery in the treatment of extensive tumors in the anterior and middle cranial fossa.

A retrospective analysis was conducted on the clinical data of 38 patients with anterior and middle cranial fossa tumors admitted to Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University from July 2015 to December 2017. All patients underwent endoscopic endonasal surgery combined with microsurgery, and skull base reconstruction was performed during the same time period. Among them, 16 patients underwent conventional skull base reconstruction, 13 underwent nasal septum mucosa skull base reconstruction, and 9 patients underwent frontal sinus drainage and skull base reconstruction. Postoperative clinical and imaging evaluations were performed to document the gross total tumor resection rate and the incidence of complications. The tumor recurrence rate and patient′s survival rate were followed up at 12 months post operation.

Among all 38 patients, total resection of tumor was achieved in 27 cases (71.0%), subtotal resection in 8 cases (21.1%), and partial resection in 3 cases (7.9%). Postoperative histopathological examination indicated inverted papilloma with dysplasia in 6 cases, squamous cell carcinoma in 5, malignant melanoma in 5, adenoid cystic carcinoma in 4, inverted papilloma in 4, adenocarcinoma in 3, chondrosarcoma in 3, olfactory neuroblastoma in 2, solitary fibrous tumor in 1, hemangiopericytoma in 1, lymphoid epithelial carcinoma in 1, embryonic rhabdomyosarcoma in 1, meningioma in 1 and myoepithelial carcinoma in 1. Among 38 patients, 35 cases did not have cerebrospinal fluid leakage after operation, and the skull base reconstruction effect was good; 3 cases (7.9%) developed transient cerebrospinal fluid leakage and intracranial infection, 1 case (2.6%) had vision loss, and 3 cases (7.9%) had restricted eye movements. There was no frontal sinusitis. The follow-up time of 38 patients was 14.5±2.8 months (12-18 months). At 12 months post surgery, the survival rate of 38 patients was 100%, and 5 patients (13.2%) had tumor recurrence.

Endoscopic endonasal surgery combined with microsurgery for the treatment of tumors involving the anterior and middle cranial fossa, with skull base reconstruction performed at the same time, seems to have good short-term efficacy and relatively few complications such as postoperative cerebrospinal fluid leakage and intracranial infection.

To screen the key genes involved in the malignant progression of gliomas and temozolomide resistance and to analyze their expression and significance in gliomas based on the transcriptomics data.

This study was conducted based on analysis of the transcriptome data in GSE23806 dataset (63 cases), Catalogue of Somatic Mutations in Cancer (COSMIC) dataset (34 cases), and Chinese Glioma Genome Atlas (CGGA) dataset (325 cases). The differential genes highly expressed in glioma stem cells, differential genes highly expressed in temozolomide resistant cells, and genes related to the malignant prognosis of glioblastoma (GBM) were screened out. The common differential genes were identified. The CGGA and Cancer Genome Atlas (TCGA) dataset (636 cases) were used to verify the differential expression of that gene in glioma with different WHO grades and subtypes. Kaplan-Meier survival curve was used to compare the overall survival of GBM patients with different gene expression levels. Univariate and multivariate Cox regression analyses were used to analyze the effect of the gene on the overall survival of patients. Gene ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were used to predict its potential biological function.

By analyzing the common differential genes, fucosyltransferase Ⅶ (FUT7) was selected as the target gene. FUT7 was highly expressed in glioma stem cells (P=0.025) and temozolomide resistant cells (P=0.033). In both CGGA (325 cases) and TCGA dataset (636 cases), the expression levels of FUT7 were different between WHO Ⅱ, Ⅲ and Ⅳ grades (all P<0.001) with the lowest in WHO Ⅱ grade and highest in WHO Ⅳ grade. In the two datasets, the expression levels ofFUT7 were different between the subtypes (all P<0.001). The mesenchymal subtype had the highest expression level ofFUT7 expression. Among GBM patients with survival data in the CGGA (138 cases) and TCGA datasets (168 cases), the patients with high FUT7 expression had shorter survival period than those with low FUT7 expression (P=0.002 and P=0.013, respectively). Univariate regression Cox analysis showed that the expression level of FUT7, radiotherapy and chemotherapy were influential factors in the overall survival of GBM patients (P<0.05). The multivariate Cox regression analysis showed that the expression level ofFUT7, radiotherapy and chemotherapy were independent risk factors (P<0.001). GO functional enrichment analysis showed that the genes positively correlative withFUT7 expression were enriched in immune response, inflammatory response, apoptosis, chemotaxis, leukocyte migration and cell proliferation. KEGG pathway enrichment analysis showed that genes positively correlative with FUT7 were enriched in JAK-STAT signaling pathway, TNF signaling pathway and NF-κB signaling pathway.

FUT7 might affect the malignant progression of glioma and temozolomide resistance through the mechanism which may be related to immune response, inflammatory response, apoptosis, drug chemotaxis, leukocyte migration and cell proliferation function, JAK-STAT3 and NF-κB signaling pathway.

To comprehensively evaluate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the neuropsychological function of patients with Parkinson′s disease (PD) with meta analysis.

Randomized controlled trials (RCTs) of STN-DBS for PD were retrieved from PubMed, Embase, Cochrane library, CNKI, WanFang, VIP from the establishment of the databases to December 1st, 2019 using the following key words: subthalamic nucleus, STN, deep brain stimulation, DBS, Parkinson disease, neuropsychological. The Jadad scale was applied to evaluate the quality of the studies. Meta-analysis was performed using the software of Revman 5.3 to evaluate the effects of STN-DBS on the neuropsychological function in patients with PD.

A total of 5 studies with Jadad score≥4 involving 740 PD patients were included. Meta-analysis showed that compared with those receiving drug therapy alone, patients undergoing STN-DBS had significantly better results in terms of the Beck Depression Inventory scores (SMD=-0.27, 95%CI: -0.47-0.06, P=0.010). In contrast, STN-DBS significantly reduced the scores of verbal fluency (phonemic fluency: SMD=-0.44, 95%CI: -0.63-0.25, P<0.001; semantic fluency:SMD=-0.29, 95%CI: -0.47-0.10, P=0.002). There were no significant differences between pre- and post-treatment according to the indexes including Mattis Dementia Rating Scale (MDRS), Wechsler Adult Intelligence Scale (WAIS) Digit Span, Wisconsin Card Sorting Test (WCST), Trail Making Test Part A (TMT-A), Boston Naming Test (BNT) in both groups (MDRS: SMD=0.03, 95%CI: -0.15-0.21, P=0.72; WAIS Digit Span forward: SMD=0.06, 95%CI: -0.16-0.28, P=0.61; WAIS Digit Span backward: SMD=-0.14, 95%CI: -0.36-0.08, P=0.21; WCST categories achieved: SMD=-0.23, 95%CI: -0.57-0.11, P=0.19; TMT-A: SMD=-0.08, 95%CI: -0.31-0.15, P=0.50; Boston Naming Test: SMD=-0.03, 95%CI: -0.29-0.24, P=0.85).

STN-DBS may improve the depressive symptoms of patients with PD without affecting the overall cognitive function. However, there seems to be postoperative decline of verbal fluency.