Volume 39 · Issue 05 · 2023

Chordoma is a rare, slow-growing, locally aggressive and destructive malignant bone tumor^[1,2,3]。 Chordomas tend to occur in axial bones such as skull base and spine, and about 30% of them originate in skull base. Due to the characteristics of deep anatomical location, wide invasion range, complex and fragile peripheral nerves and blood vessels, insensitivity to conventional radiotherapy and easy recurrence, the diagnosis and treatment of skull base chordoma requires the cooperation of neurosurgery, otolaryngology, head and neck surgery, oral and maxillofacial surgery, plastic surgery, radiotherapy, oncology, pathology and imaging doctors. However, in clinical practice, doctors in related disciplines still have insufficient understanding of it, and diagnosis and treatment need to be standardized urgently. Skull Base Surgery Branch of China Association for the Promotion of International Medical Care Exchange, Skull Base Surgery Branch of European and American Alumni Association Physicians Association, and Neurosurgery Branch of China Association for the Promotion of International Medical Care Exchange organized the above-mentioned multidisciplinary experts with rich experience in clinical diagnosis and treatment of chordoma by reading literature, sorting out work experience, summarizing relevant research results, and repeatedly discussing and forming the following opinions for the reference of medical staff in related fields, in order to help the standardized treatment and clinical research of skull base chordoma.

To compare the safety and efficacy of overlapping stents-assisted coil embolization and flow diversion (FD) alone for the treatment of unruptured intracranial vertebrobasilar trunk aneurysm (uiVBTA).

A retrospective study was conducted on the clinical data of 105 patients with uiVBTA who were treated with overlapping stents-assisted coil embolization or FD alone from January 2015 to July 2022 at the Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University. According to the treatment methods, all patients were divided into the overlapping stents-assisted coil embolization group (multi-stent group, 65 patients, 68 aneurysms) and flow diversion (FD) alone group (FD group, 40 patients, 42 aneurysms). The aneurysmal complete occlusion, adequate occlusion and postprocedural neurological complications were evaluated by digital subtraction angiography (DSA) and head CT or MRI. The modified Rankin Scale (mRS) was used to evaluate the clinical outcomes of the patients. Postprocedural complications and therapeutic effects were compared between the two groups.

The implantations were successful in both groups. There was no statistically significant difference between the two groups in baseline characteristics (all P>0.05). Periprocedural complications occurred in 10 patients (10/105, 9.5%), including 5 patients (5/65, 7.7%) in the multi-stent group and 5 patients (5/40, 12.5%) in the FD group. All patients obtained clinical follow-up, with the median follow-up time of [M(Q₁, Q₃)] 28 (11, 52) months. The last follow-up showed that the complication rate in the multi-stent group and FD group was 10.8% (7/65) and 7.5% (3/40), respectively; the mortality rate was 6.2% (4/65) and 7.5% (3/40), respectively; the percentage of favorable outcome rate (mRS≤2 scores) was 90.8% (59/65) and 90.0% (36/40), respectively. The differences were not statistically significant (all P>0.05). A total of 59 patients (61 aneurysms) received imaging follow-up, and the follow-up time [M(Q₁, Q₃)] was 8 (6, 12) months. The last follow-up showed that the rate of complete aneurysm occlusion was 88.9% (32/36) in the multi-stent group and 64.0% (16/25) in the FD group, and the difference was statistically significant (P=0.020). The adequate occlusion rate was 91.7% (33/36) in the multi-stent group and 88.0% (22/25) in the FD group, with no statistical difference (P=0.971).

Overlapping stents-assisted coil embolization in the treatment of uiVBTA appears to have a higher complete occlusion rate compared with FD treatment. No difference has been observed in terms of the rate of adequate occlusion and postprocedural complication. Both groups have high safety and efficacy, while the occurrence of fatal complications remains to be noted.

To explore the efficacy of superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass with encephalo-duro-myo-pericranio-synangiosis (EDMPS) combined with ipsilateral frontal burr hole for moyamoya disease with spontaneously formed collaterals of the middle meningeal artery (MMA).

The clinical data of 19 patients (3 children and 16 adults) of moymoya disease affecting 20 cerebral hemispheres with spontaneously compensated MMA treated by STA-MCA+ EDMPS+ frontal burr hole surgery in the Department of Neurosurgery of Aviation General Hospital from August 2020 to October 2021 were retrospectively analyzed. One week after operation, three-dimensional reconstruction of head CT angiography (CTA) was performed to evaluate the scope of craniotomy and patency of bypass vessels. Outpatient and (or) telephone follow-up was conducted at 12 months post operation to observe the surgical complications. Head CT or MRI and cerebral vascular DSA(digital subtraction angiography) were performed every 6 months after operation, and the growth of collateral vessels was evaluated by Matsushima staging. CT perfusion(CTP) was re-examined at 1 week, 3 months, and 6 months after operation to evaluate the brain perfusion.

All 20 operations in 19 patients were successfully completed. The postoperative three-dimensional CT reconstruction of the skull showed that the combined vascular bypass surgery covered the MCA area, and the frontal burr hole was located in the anterior cerebral artery(ACA) area of the medial frontal area. One week after operation, CTA and CTP showed that the bypass vessel was unobstructed, and the cerebral blood flow in the bypass region was improved compared with that before operation. Preoperative TIA (transient ischemic attack) symptoms of all 8 patients disappeared after operation. Five adult patients had postoperative hyperperfusion symptoms, which were relieved after drug treatment. The average follow-up time of 19 patients was 10.2±4.2 months (5-19 months). During the follow-up period, neither the children nor adults experienced ischemic or hemorrhagic stroke events. At 12 months after surgery, 9 adults and 1 child were re-examined by cerebral DSA. The results showed that the STA-MCA bypass was unobstructed in 8 patients and not visualized in 2. In the MCA region, Matsushima grade A was reported for the collateral cerebral vessels in 6 cases (including 1 child), grade B in 3 cases, and grade C in 1 case. The moyamoya vessels disappeared or decreased in all 10 patients. In the ACA region, the collateral vessels appeared in 6 cases, which all originated from the supraorbital artery and entered the frontal region through the burr hole.

Using STA-MCA+ EDMPS combined with frontal burr hole surgery to treat moyamoya disease with spontaneously formed collaterals of MMA may help form relatively good bypass vessels in the frontal lobe and improve the blood supply of the medial frontal lobe without damaging the pre-existing MMA, which seems safe and effective.

To investigate the angioarchitectural risk factors associated with postoperative cerebral infarction in patients with ischemic moyamoya disease (MMD).

The clinical data of 418 patients who underwent 535 surgical operations for ischemic MMD in the Department of Neurosurgery, Peking University International Hospital from October 2015 to October 2020 were retrospectively analyzed. Among them, 261 patients underwent 326 operations by combined revascularization (CR group) and 157 patients underwent 209 operations by indirect revascularization (EDAS). The sex, age, side of surgery, TIA (transient ischemic attack), old cerebral infarction, and carotid artery (ICA) stenosis, ACA A1 stenosis, MCA M1 stenosis, posterior cerebral artery (PCA) anomaly, presence of posterior circulation compensation, unstable compensation and extracranial compensatory vascular structural factors were analyzed separately with the incidence of cerebral infarction within 1 week after surgery. Indexes with statistically significant differences were included in the multivariate logistic regression model for analysis.

Cerebral infarction occurred in 49 (15.0%) of 326 CR procedures and in 38 (18.2%) of 209 EDAS procedures within 1 week after surgery. The results of multivariate logistic regression analysis showed that age(OR=1.03, 95%CI: 1.00-1.07), preoperative TIA (OR=4.26, 95%CI: 1.84-9.86), old cerebral infarction (OR=2.97, 95%CI: 1.19-7.40), ACA A1 stenosis (OR=5.84, 95%CI: 1.73-19.73), MCA M1 stenosis (OR=6.21. 95%CI: 2.08-18.53), PCA anomaly (OR=4.37, 95%CI: 1.45-13.13), and unstable compensation (OR=5.34, 95%CI: 1.43-19.95) were independent risk factors for cerebral infarction after CR surgery (all P<0.05). Age (OR=1.04, 95%CI: 1.01-1.06), old cerebral infarction (OR=2.89, 95%CI: 1.15-7.28), ACA A1 stenosis (OR=4.19, 95%CI: 1.59-11.07) and PCA anomaly (OR=2.78, 95%CI: 1.11-7.01) were independent risk factors for cerebral infarction after EDAS surgery (all P<0.05).

Preoperative angioarchitectural factors are important risk factors for cerebral infarction after various revascularization procedures in patients with ischemic MMD.

To investigate the safety and efficacy of Onyx-18 embolization via different approaches in the treatment of anterior fossa base dural arteriovenous fistula (ACF-DAVF).

A retrospective analysis was conducted on the clinical data of 11 patients who underwent Onyx-18 embolization for ACF-DAVF in the Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from November 2018 to January 2022. All patients showed ACF-DAVF of Cognard type Ⅳ based on preoperative digital subtraction angiography (DSA). Embolization was performed individually through the ophthalmic artery, middle meningeal artery anterior falciform branch, middle meningeal artery anterior falciform branch combined with ophthalmic artery and veins according to the supplying artery and draining vein. DSA review and Class grading were performed immediately after surgery to evaluate the embolization degree. The therapeutic effect, complications and follow-up results of embolization via different approaches were analyzed.

In 11 patients, a total of 11 embolization procedures were all successfully completed. Among them, 5 cases were embolized by ophthalmic artery access, 4 cases were Class Ⅰ, 1 case was Class Ⅱ, and 1 case had delayed bleeding after surgery. Three cases were embolized by middle meningeal artery anterior falciform branch access, all were Class grade Ⅰ, and no perioperative complications occurred. One case undergoing embolization via the middle meningeal artery anterior falciform branch combined with the ophthalmic artery was Class Ⅰ and developed pain in the left orbital region after surgery which disappeared 2 days later. Two cases were both embolized by venous access and Class grade Ⅰ, and no perioperative complications occurred. The follow-up time of the 11 patients was 11.3±6.1 months (3-23 months). Ten patients underwent DSA review which showed complete occlusion of fistula in all cases. One received skull magnetic resonance angiography reexamination which showed no abnormal vascular lesion at the bottom of the anterior cranial fossa. The latest follow-up showed that all the patients′ presurgical clinical symptoms such as headache, dizziness or epileptic seizure disappeared or were alleviated.

Onyx-18 glue embolization seems to be a safe and effective method for the treatment of ACF-DAVF according to the characteristics of supplying artery and draining vein.

To evaluate the efficacy of hybrid surgery for symptomatic extracranial vertebral artery occlusion.

A retrospective analysis was conducted on the clinical data of 9 patients with symptomatic extracranial vertebral artery occlusion who underwent hybrid surgery at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from April 2021 to August 2022. All patients were treated with vertebral artery endarterectomy combined with endovascular treatment (hybrid surgery). Incision healing, vocal cord function, pupil and eyelid movement were observed after surgery. Head MRI diffusion weighted imaging (DWI), extracranial vertebral artery CT angiography (CTA) or digital subtraction angiography (DSA) was reviewed within 7 days after surgery, and the modified Rankin scale (mRS) score was recorded at discharge. Clinical and imaging follow-up was performed 3 months after surgery, including posterior circulation ischemic stroke, mRS score and death events. Imaging follow-up included CTA or DSA.

The extracranial vertebral artery was recanalized successfully in all 9 patients and intraoperative vascular dissection occurred in 1 case. All patients were implanted with stents, with 1 stent in 1 patient, 2 stents in 3 patients, and 3 stents in 5 patients. There was no symptomatic or asymptomatic cerebral infarction. Horner syndrome occurred in 2 patients, hoarseness in 2 patients, and local incision infection in 1 patient after surgery. Extracranial vertebral artery CTA reexamination results showed that 8 patients achieved successful recanalization while 1 case had asymptomatic vascular occlusion. At discharge, the mRS score was 0 in 7 patients and 1 in 2 patients. The follow-up period of the 9 patients was 3-18 months. The mRS score was 0 in 7 patients and 1 in 2 patients. There was no new cerebral infarction occurring in the 9 patients. The vertebral artery was patent in 8 patients.

Preliminary observations have found that hybrid surgery is effective and relatively safe in the treatment of patients with symptomatic extracranial vertebral artery occlusion.

To investigate the therapeutic efficacy of intracranial venous sinus stenting for the treatment of idiopathic intracranial hypertension (IIH) complicated with cerebral venous sinus stenosis (CVSS).

A retrospective analysis was conducted on the clinical data of 26 patients with IIH accompanied by limited CVSS who were admitted to the Cerebrovascular Department of Interventional Center of Henan Provincial People′s Hospital from December 2012 to December 2021. All patients underwent intracranial venous sinus stenting. Clinical follow-up was performed to measure intracranial pressure (ICP) and observe the improvement of clinical symptoms and whether there were complications or new symptoms. Postoperative imaging follow-up was performed to evaluate the patency of blood flow in and beside the stent.

The technical success rate of surgical procedures in 26 patients was 100%. A total of 27 stents were implanted in the operation, and immediate postoperative angiography showed that venous sinus stenosis disappeared. The pressure gradient in the original stenosis decreased significantly after surgery (median gradient: 0 vs. 14 mm Hg, 1 mm Hg=0.133 kPa, P<0.001). Preoperative tinnitus in 3 cases disappeared, headache in 14 cases and visual impairment in 23 cases were relieved to varying degrees. No serious complications such as stent thrombosis or intracranial hemorrhage occurred. Four cases (4/26, 15.4%) had transient unilateral headache on the side of surgery, which disappeared within 3-5 days. At 3 months post surgery and among the 26 patients, 2 cases had high ICP, 6 cases had slightly high ICP, and 18 cases had normal ICP, which was statistically different from preoperative conditions (26 cases with high ICP) (P<0.001). Twenty-six patients were followed up for a median duration of 52.5 months (5-116 months). None of the patients had recurrence of original symptoms and no new symptoms of neurological impairment were reported during follow-up. No optic disc edema was found in 22 patients who underwent fundus and visual field examination. There were 12 patients (54.5%) showing improved visual field and 10 patients (45.5%) having normal visual field. Imaging follow-up was completed in 17 patients, with a median follow-up time of 4 months (3-7 months). The results showed that none of the 17 patients had obstructed intracranial venous sinuses, good stent shape and location were demonstrated, and there was no restenosis in or around the stent.

Venous sinus stenting seems effective for the treatment of IIH and correction of CVSS with few complications and satisfactory follow-up results.

To investigate the therapeutic effect of decompressive craniotomy in the treatment of hemorrhagic intracranial venous sinus thrombosis complicated with cerebral herniation.

A retrospective analysis was conducted on the clinical data of 7 patients of hemorrhagic intracranial venous sinus thrombosis complicated with cerebral hernia who underwent decompressive craniotomy in the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University (5 cases) and the Department of Neurosurgery of Lhasa People′s Hospital (2 cases) from October 2019 to August 2022. The median Glasgow coma score (GCS) of patients before operation was 6 (3-11). Intracranial venous sinus thrombosis complicated with cerebral herniation was confirmed by imaging examination before operation in all patients, and the disturbance of consciousness was progressively aggravated. All patients underwent decompressive craniectomy, and 5 patients underwent simultaneous hematoma evacuation. The therapeutic effect and outcome were evaluated by GCS at 1 week after operation and modified Rankin Scale (mRS) at 3-6 months after operation.

The operations of 7 patients were all successfully completed. One week after operation, the GCS ranged from 3 to 15. Two cases died 1 day after operation, and 1 case died 31 days after operation. The follow-up period of 4 surviving patients ranged from 3 to 36 months. Postoperatively, the patients were treated with oral anticoagulant drugs for 3 to 12 months, and no new intracranial venous sinus thrombosis or hemorrhage was found in CT venous angiography or magnetic resonance venography after 3 to 6 months. By the last follow-up, 2 cases had good outcome (mRS: 1-2), and 2 cases had poor outcome (mRS: 3).

For patients with hemorrhagic intracranial venous sinus thrombosis complicated by cerebral herniation, decompressive craniotomy can improve the outcome of patients to a certain extent, but the overall prognosis of the disease seems poor.

To observe the clinical efficacy and safety of Pipeline embolization device (PED) in the treatment of unruptured dissecting aneurysms of M1 segment of middle cerebral artery. The clinical data of 6 patients (7 aneurysms) with unruptured dissecting aneurysms in the M1 segment of the middle cerebral artery treated with PED in the Department of Neurosurgery of Shanghai Donglei Brain Hospital from January 2015 to January 2021 were retrospectively analyzed. Three patients were treated with coil assisted PED, and three patients were treated with PED alone. A total of 6 PEDs were placed in 6 patients, and the stents were successfully released. One patient developed postoperative ipsilateral cerebral parenchymal hematoma. The median follow-up time of the 6 patients was 36 months (12 to 80 months). Up to the last follow-up, there were no arterial thromboembolic events, and the modified Rankin scale score was 0 in 5 cases and 1 in 1 case; Six aneurysms O'Kelly-Marotta (OKM) grade D healed in 5 patients and a single aneurysm OKM grade B healed in 1 patient.

To explore the application of combined use of the double osteotomy of the retrosigmoid sinus and mastoid cortical bone with muscle layer repositioning and suturing reconstruction technique in the surgical treatment of lesions in the jugular foramen via the retroauricular far-lateral approach.

A retrospective analysis was performed on the clinical data of 16 patients with jugular foramen tumors who underwent resection via the retroauricular far-lateral approach at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from January to December 2020. Intraoperatively, all cases were managed using the muscle layer repositioning technique, double osteotomy of the retrosigmoid sinus and mastoid cortical bone and muscle layer suturing reconstruction. The study evaluated the efficacy of skull base reconstruction and the occurrence of complications such as cerebrospinal fluid leakage and subcutaneous fluid accumulation.

Surgical operations were successfully performed and gross total resection was acquired in all 16 patients. Pathological results showed that there were 12 cases of schwannoma, 3 cases of paraganglioma and 1 case of chondrosarcoma. After operation, 2 cases had new-onset neurological dysfunctions, and 6 cases experienced aggravation of pre-existing neurological dysfunctions. None of the patients had subcutaneous fluid accumulation or cerebrospinal fluid leakage. All patients had good fixation of the double bone flaps as shown on postoperative head CT without evidence of twisting or loosening. Restoration of the morphological features of the mastoid was shown with minimal skull defect. The follow-up time for the 16 patients was 31.4±3.5 months (27-37 months). At the last follow-up, all wounds had healed well, and there were no cases of skull flap deformation, displacement or tumor recurrence.

Double osteotomy of the retrosigmoid sinus and mastoid cortical bone with muscle layer repositioning and suturing reconstruction technique is a simple surgical procedure that increases safety, reduces bony defects, promotes soft tissue reconstruction and ensures an adequate exposure range. Its use in the surgical treatment of lesions in the jugular foramen area via the retroauricular far-lateral approach seems safe and effective.

To investigate the clinical characteristics and treatment of suprasellar arachnoid cysts (SAC) with ectopic choroidal heterotopia and to explore the mechanisms of SAC enlargement.

The clinical data of 19 cases with SAC admitted to the Department of Neurosurgery, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from February 2017 to February 2022 were retrospectively studied. The patient′s median age was 9.4 months (1-48 months). SAC was identified in 17 cases by fetus MRI when the mothers underwent physical examination during pregnancy and in the other 2 cases in early childhood (6 and 42 months respectively) and then the diagnosis of SAC were established. Progressive enlargement of SAC was shown in 17 patients before operation. The cyst was localized in the suprasellar cistern in 2 cases, while the cyst in the remaining 15 cases expanded from the suprasellar cistern to the periphery, compressing the temporal lobe, parietal lobe, occipital lobe, cerebellum or medulla oblongata. Two cases were accompanied with moderate hydrocephalus. The ventricles shrank and shifted due to compression by cysts in 7 cases. Normal ventricles were found in 10 cases. Endoscopic cystocisternostomy (ECC) was performed in 8 patients and endoscopic third ventriculocystocisternostomy (EVCC) was performed in 11. Regular imaging follow-up was used to observe the changes of the cysts to determine whether the cysts recurred.

The choroidal heterotopia in suprasellar arachnoid cyst inside the sellar region was identified in all cases during operations. The procedures were successfully performed without any complications. The mean clinical follow-up period was 12.8±7.0 months(3-24 months)in 19 children. The size of the cyst decreases by >50% in 17 patients with good growth and development and MRI showed no recurrence. Two patient who underwent ECC had lesion recurrence post operation. Of them, recurred cyst shrank after cystoperitoneal shunting in 1 case and resolved after EVCC in the other.

The SAC identified in fetus and the early stage of childhood shows the clinical characteristics of rapid enlargement and expansion to adjacent regions. Secretory action of the ectopic choroidal heterotopia may play an important role in the mechanism of SAC. EVCC should be the primary treatment method for suprasellar cistern cyst.

To investigate the clinical therapeutic efficacy of syringomyelia-subarachnoid shunt via the dorsal root entry zone (DREZ) approach for the treatment of eccentric syringomyelia.

A retrospective study was performed on the clinical data of 21 patients with idiopathic or secondary eccentric syringomyelia (with failure in etiological treatment) and admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Naval Medical University from June 2018 to June 2021. Cavities were located in the neck and thoracic spinal cord. All patients underwent syringomyelia-subarachnoid shunt via DREZ approach. The modified Japanese Orthopedic Association (mJOA) low back pain scale was used to evaluate the improvement of clinical symptoms, and MRI was used to evaluate the improvement of the syringomyelia (reduction of the cavity volume by ≥ 50% was considered significant improvement).

All 21 patients underwent successful operations. Temporary upper extremity numbness and cerebrospinal fluid leakage occurred in 1 case after operation, and no case of shunt blockage, central nervous system infection or death occurred in any patient. After 3 and 12 months of follow-up, 17 (81.0%) and 20 (95.2%) patients had improved clinical symptoms; the mJOA low back pain scale scores were 11.6±1.1 points, 11.3±1.3 points respectively, and both showed improvement compared with preoperative conditions (8.1±1.3 points) (P<0.001). Imaging follow-up showed that the syringomyelia of 19 patients (90.5%) was significantly improved at 3 months after operation, and the syringomyelia of 20 patients (95.2%) was significantly improved at 12 months after operation.

For patients with idiopathic or secondary eccentric syringomyelia with failed etiological treatment, syringomyelia-subarachnoid shunt via DREZ approach is a safe and effective treatment.

To identify the role of interictal scalp electroencephalography (EEG) in the surgical treatment of intractable epilepsy caused by focal cortical dysplasia (FCD) type Ⅱ.

A retrospective study was conducted on the clinical data of 96 patients with intractable epilepsy caused by FCD type Ⅱ confirmed by postoperative pathology in the Department of Neurosurgery Beijing Fengtai Hospital from April 2015 to December 2019. We compared and analyzed the accuracy of preoperative scalp EEG interictal discharges (IEDs) and ictal discharges (IDs) in locating epileptogenic zones, as well as their predictive effects on postoperative outcomes.

Of the 96 patients, 77 (80.2%) showed focal/regional distribution of IEDs, which was consistent with the area of surgical resection, and the accurate localization of the area of resection was 80.2% (77/96); 19 (19.8%) showed non-focal/regional distribution. Of the 96 patients, 73 (76.0%) showed focal/regional distribution of IDs, 23 (24.0%) showed non-focal/regional distribution, and the accuracy of IDs for localizing was 75.0% (72/96), as the focal/ regional distribution of IDs was not consistent with the area of surgical resection in 1 patient. There was significant difference between IEDs and IDs in the localization accuracy of FCD Ⅱ lesions (P<0.001). The 96 patients were followed up for 26-77(M: 55.5)months. Engel class Ⅰ was reported in 86 patients (89.6%) and class Ⅱ-Ⅳ in 10 patients (10.4%). In Engel class Ⅰ group, 73 patients (84.9%) showed focal/regional IEDs and 13 patients (15.1%) showed non-focal/ regional IEDs. In Engel class Ⅱ-Ⅳ group, 4 patients (4/10) showed focal/regional IEDs, and 6 patients (6/10) showed non-focal/regional IEDs. There was significant difference in the distribution of IEDs between the two groups (P=0.003). However, there was no significant difference in the distribution of IDs between the two groups (P=0.387).

The distribution of IEDs in the preoperative scalp EEG has a higher accuracy in locating surgical lesions in patients with FCD type Ⅱ drug-refractory epilepsy, and can predict the postoperative efficacy.

To establish a method for parallel detection of copy number variation of multiple targets (chromosomes 1, 19, 7 and 10, EGFR, CDKN2A/B gene) for adult gliomas.

A method of detection of multi-target copy number variation by second-generation sequencing technology was established in this study. Five clinical samples with known copy number variation information by whole-exon sequencing were used as standard samples to evaluate the accuracy of the established detection method. The in situ fluorescence hybridization (FISH) method was used to evaluate the ability of the detection method to distinguish the heterozygosity loss and homozygosity loss of CDKN2A/B gene. A total of 77 clinical samples from the Chinese Glioma Genome Atlas Project (CGGA) were retrospectively collected to evaluate the clinical practicability of the detection method.

The established targeted copy number sequencing method could be used to accurately detect copy number variations of multiple variants of EGFR, CDKN2A/B, chromosomes 1, 19, 7, and 10 in 5 standard samples. Compared with the FISH assay results, the copy-number targeted sequencing method was able to accurately distinguish the CDKN2A/B homozygous and heterozygous deletions. The established method met the testing requirements of chromosomes 1, 19, 7, and 10, EGFR, and CDKN2A/B in 77 clinical samples. According to the detection results, 77 samples could be used for accurate classification and grading according to the 2021 World Health Organization classification system of the central nervous system tumors.

The copy number variation targeted sequencing method based on the second-generation sequencing technology can simultaneously detect the copy number variation of multiple targets (chromosomes 1, 19, 7 and 10, EGFR, CDKN2A/B) in glioma samples, which is suitable for routine clinical molecular pathological detection.

Cerebral hemorrhage often leads to severe white matter damage, and 7T MRI diffusion tensor imaging can evaluate the integrity of white matter fibers in vivo. From May 2021 to March 2022, 7T MRI diffusion tensor imaging was used to evaluate the white matter fiber changes in 2 patients with basal ganglia hemorrhage in the Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine. One patient underwent stereotactic hematoma evacuation and one patient received only conservative treatment. It was found that the recovery of white matter fibers in patients treated with minimally invasive surgery was better than that in patients treated with conservative surgery, and the changes of white matter fibers mainly concentrated around hematoma and brain areas related to cognitive and emotional functions.

Intravascular lymphoma (IVL) is a rare subtype of diffuse large B-cell lymphoma, which is highly aggressive, lacks specificity in clinical manifestations, laboratory and imaging examinations, has a high rate of misdiagnosis and poor clinical prognosis. A patient with IVL with cervical intramedullary hemorrhage was admitted to the Department of Neurosurgery of Chengdu Second People's Hospital. Spontaneous cervical intramedullary hemorrhage caused by cavernous malformation of the spinal cord was considered preoperatively, and IVL was diagnosed postoperatively by pathology. He died 20 d after surgery due to disease progression.

Leiomyosarcoma is a common soft tissue tumor with poor prognosis and high recurrence and metastasis rates. Leiomyosarcoma occurring under the scalp is rare in clinic and difficult to diagnose before operation. In August 2020, a patient with subscalp leiomyosarcoma was admitted to the Department of Neurosurgery, Hengshui People's Hospital, Hebei Province. After two operations, he relapsed rapidly. Radiotherapy can effectively inhibit the growth of the tumor for a time. The detection of tumor-specific immunohistochemical indexes before operation can provide a basis for definite diagnosis. Perfect preoperative examination and multi-department collaborative consultation may be beneficial to optimize the scope of surgical resection.

Glioma, as the most common primary malignant tumor in the cranium, has a poor prognosis. Microglia (MG), as the resident immune cells of the central nervous system, is one of the core elements of immune regulation in the tumor microenvironment. MG is able to respond rapidly to alterations in the immune microenvironment in which it resides and plays a key role in glioma proliferation, invasion, metastasis, immune evasion, and therapy resistance, a plasticity mainly attributed to its ability to adapt to specific phenotypes. This paper reviews the research status of functional diversity of MG under physiological and pathological conditions and its heterogeneity and immunomodulatory function related to glioma, in order to provide new ideas for the treatment of glioma.

There are many causes of tinnitus, and its pathogenesis is not yet clear. The prevailing view is that tinnitus is associated with both the auditory center and the peripheral nerves. The treatment of tinnitus should first target the cause, but there is no effective treatment for intractable tinnitus at present. In recent years, progress has been made in neuroimaging research of intractable tinnitus, which makes people have a deeper understanding of the mechanism of tinnitus. Various neuromodulation techniques have achieved certain therapeutic effects in the treatment of intractable tinnitus, and have good application prospect. Combined with the etiology and related pathophysiological mechanisms of tinnitus, this paper reviews the neuromodulation techniques and curative effects currently used in the treatment of intractable tinnitus.

Intracranial aneurysms have been a serious threat to human health for a long time, so it is critical to study and analyze the pathogenesis and intervention measures of intracranial aneurysms. At present, with the deepening of research on intracranial aneurysms, some scholars have proposed that intracranial aneurysms are closely related to human colonized microbial flora (such as intestinal flora, oral colonized flora, etc.). In this paper, the influence of human colonized microbial flora on the production of intracranial aneurysms and the potential intervention mechanism of aneurysms were reviewed, and the relationship between each microbial flora and intracranial aneurysms was briefly discussed.

Studies have confirmed that prognostic factors affecting patients with traumatic craniocerebral injury (TBI) include secondary brain injury, systemic immune dysfunction, and digestive system dysfunction. Among them, the prognosis of TBI patients is closely related to gastrointestinal dysfunction and the destruction of intestinal mucosal barrier, especially the regulation of intestinal flora and brain-intestinal axis plays an important role in the body's nutrient absorption and maintenance of intestinal barrier. In addition, intestinal flora plays an important role in the regulation of immunity, metabolism, homeostasis and molecular signaling in TBI patients. Recent studies have shown that flora transplantation and probiotic therapy can promote the recovery of immune and metabolic functions of TBI patients, thus improving the prognosis and promoting the recovery of neurological function; However, its specific mechanism is currently unclear. Therefore, this article reviews the progress of research on the influence of intestinal flora on the prognosis of TBI patients.

Dystonia is a dyskinesia that occurs repeatedly with abnormal movements and/or postures caused by persistent or intermittent muscle contractions. With the development of molecular biology, the genetic characteristics and molecular biological mechanisms of dystonia have been revealed. In the past 20 years, numerous gene mutations related to dystonia have been reported, and their functions cover a wide range of biological processes. This article will focus on the review of various biological mechanisms related to hereditary dystonia, in order to provide help for further scientific research and precise treatment of this disease.

Hypotensive hydrocephalus is a special type of hydrocephalus, which is rarely seen in clinic and rarely reported in literature. Due to insufficient understanding of it, clinical diagnosis and treatment are difficult, and patients are often misdiagnosed as other forms of hydrocephalus or abnormal shunt, which often delays the treatment opportunity. This article reviews the progress in the diagnosis and treatment of this particular type of hydrocephalus, aiming to improve the understanding of this disease.