2015年 · 第31卷第01期

Anterior inferior cerebellar artery aneurysms are very rare, accounting for about 0.10% ~0.98% of intracranial aneurysms^[1,2,3]。 Four cases of anterior inferior cerebellar artery aneurysms were treated in the Department of Neurosurgery of the First Affiliated Hospital of Suzhou University from January 2007 to December 2013, accounting for 0.35% (4/1 158) of the aneurysms in the same period. The clinical characteristics, surgical skills and clinical results are reported as follows in combination with the literature.

Intracranial aneurysm is an abnormal bulge of the artery wall caused by the localized abnormal enlargement of the lumen of the intracranial artery. It is a common and serious cerebral hemorrhagic disease^[1]In neurosurgical diseases, it is known as a "time bomb"^[2]。 Its morbidity ranks third among patients with cerebrovascular accidents, second only to cerebral thrombosis and hypertensive cerebral hemorrhage, but its mortality and disability rate are extremely high^[3]。 The surgical treatment of intracranial aneurysms includes two strategies: aneurysm clipping and endovascular interventional surgery. The former is a classic and traditional operation, which has been regarded as the "gold standard" for intracranial aneurysms in recent decades^[4]Vascular interventional surgery is a new technology developed in the past 20 years. In recent years, microsurgical clipping and endovascular intervention techniques have been continuously developed and improved. However, it is still uncertain which of the two treatments is the best in terms of safety and effectiveness. Therefore, this paper incorporates the literature published at home and abroad in the past 15 years on the comparative study of intracranial aneurysm interventional treatment and clipping surgery for meta-analysis, and calculates the odds ratio,OR) and 95% confidence interval (confident interval,CI) to represent the size of the effect. The safety and effectiveness of the two methods were compared from several aspects, so as to provide objective basis and theoretical guidance for the choice of surgical methods for patients with intracranial aneurysm.

Aneurysm rupture is the most common cause of spontaneous subarachnoid hemorrhage (SAH). Surgical treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH) often achieves good results, with no or only minor neurological dysfunction. SAH may affect hypothalamic-pituitary axis function, and various pituitary-related hormone abnormalities may occur in the acute phase^[1]And as the condition improves, pituitary-related hormone disorders also tend to normal. However, persistent hypopituitary-associated hormone secretion may still exist during the chronic phase of the disease^[2]。 In this study, the serum thyroid-related hormones in patients with aSAH in acute and chronic phases were monitored and their changes were studied. At the same time, Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory (BDI) were used to evaluate the Cognitive function of patients with hypothyroidism in the chronic phase of aSAH, and to provide evidence for further hormone replacement therapy.

Patients with internal carotid artery aneurysms are common intracranial aneurysms, and the treatment of large or giant aneurysms in the cavernous sinus segment is relatively difficult. Because of its safety, minimally invasive and effective characteristics, endovascular treatment has become an important way to treat intracranial aneurysms. We used Apollo stent-assisted coil and Onyx18 to embolize a case of unruptured large internal carotid artery cavernous segment aneurysm, and achieved good results, which are reported below.

primary central nervous system lymphoma (PCNSL) accounts for about 7% of intracranial tumors, and most of them are diffuse large B-cell lymphoma. The median survival time after radiotherapy and chemotherapy is about 30~60 months. mucosa-associated lymphoid tissue lymphoma (MALT) originating from the central nervous system is extremely rare. All foreign literatures are case reports, but at present, there are few reports in Chinese literature. One case of primary central nervous system MALT was treated by neurosurgery in our hospital, and the report is as follows.

Male, 37 years old. "Headache and nausea for 1 year" was hospitalized on 21 October 2013. The patient went to the local hospital in August 2012 due to headache and nausea, and the MRI of the head showed hypothalamic hamartoma (FIG. 1A), that is, "gamma knife" treatment, the specific dose is unknown, and the headache symptoms are improved after treatment. In October 2013, the patient experienced headache again, and the reexamination of the head MRI showed that the lesion was larger than before (FIG. 1B)。 Admission physical examination: conscious, cooperative physical examination, both pupils are equal in size, left: right =2.5 mm: 2.5 mm, photoreaction is present, there is no loss of visual acuity in both eyes and no visual field defect in rough measurement. The muscle strength and tone of the limbs were normal, physiological reflexes existed, and pathological signs were not drawn out. Genital development is normal, and 1 child is healthy. After medical history, the patient had normal sexual life, no precocious puberty, no history of ridiculous seizures, and no personality abnormalities. There were no abnormalities in biochemical and endocrine examinations. There were no abnormalities in EEG. After admission, I actively performed preoperative examination. On October 29, 2013, I underwent "right pterional approach hypothalamic hamartoma resection" under general anesthesia. During the operation, it was found that the tumor originated from the papillary body, pointing to the interfoot pool, which was solid, gray-yellow in color, hard in texture, average blood supply, necrosis in the center of the tumor, and hard in texture in the peripheral part. The tumor was removed in blocks under the microscope, and the operation was smooth. Postoperative CT and MRI reexamination showed that the tumor was completely removed (Figure 1C), there was no abnormality in the endocrine examination, and the patient's headache disappeared. Pathological microscopy showed that most tissue was degenerative and necrotic, and a small part was small patchy brain tissue, mainly glial cells, with scattered degenerative disorderly arranged neuronal cells, accompanied by hemosiderin deposition, small blood vessel proliferation, and some blood vessel wall degeneration. Immunohistochemical staining results: GFAP (diffuse +), Olig-2 (scattered +), NeuN (scattered +), SMI32R (scattered +). Consistent with changes after hamartoma radiotherapy (Figure 1D)。 The patient recovered and was discharged on 06 Nov 2013. After 3 months of follow-up, the patient had no symptoms, and there was no recurrence of the tumor on MRI.

The incidence of intraspinal tumors is about 1/10 of the incidence of brain tumors. Tumors can occur in any segment from the cervical spinal cord to the cauda equina. It occurs most in the thoracic segment, accounting for about half. Among them, neurofibroma accounts for about 40%, and meningioma accounts for about 10% ~15%. Most of them are located on the dorsolateral side of the spinal cord, and tumors located on the ventral side of the spinal cord are rare^[1]。 It is difficult to resect ventral spinal cord lesions, especially medium and small lesions. Combined with the literature, the experience of 4 patients with ventral thoracic spinal cord tumors admitted to the Department of Neurosurgery, Wangjing Hospital, Chinese Academy of Chinese Medical Sciences from August 2011 to March 2014 using lateral anterior approach microsurgical resection is summarized as follows.

cerebellar mutism (CM) is a group of temporary clinical syndromes that occur after posterior fossa tumor surgery in children, occasionally secondary to cerebellar hemorrhage, inflammatory reaction and trauma, mainly with language disorder, often combined with oropharyngeal dyskinesia and mental changes. This article reviews its clinical characteristics, pathogenesis, prognosis and prevention.

Intracranial pressure (ICP) is the pressure in the cranial cavity. The ICP in normal adults is 0.8 to 1.8 kP a (80 to 180 mmH₂O), typically exceeding 2.0 kPa (200 mmH₂O) It is called intracranial hypertension. Intracranial hypertension is a reflection of intracranial diseases or secondary intracranial lesions, which can lead to deterioration or even death of patients. Monitoring ICP and selecting treatment measures according to ICP can effectively improve the prognosis of patients with intracranial hypertension^[1]。 At present, there are two methods to detect ICP: direct measurement and indirect measurement. Although direct measurement is reliable, it is invasive, easy to complicate intracranial infection, and its application is limited^[2]。 It is imperative to find a safe, simple and effective non-invasive ICP monitoring method that can be implemented at the bedside to guide the treatment of high ICP. This article reviews the research progress of non-invasive ICP monitoring methods.

subarachnoid hemorrhage (SAH) is the third leading cause of maternal mortality with a mortality rate of 27% ~40%^[1,2,3]。 Studies have reported that the incidence of SAH during pregnancy and maternity is 6.3~13.8 per 100,000 deliveries^[4,5], Bateman et al.^[1]The incidence of maternal SAH derived from a sample of hospitalizations throughout the United States was 5.8 per 100,000 births. The incidence of hemorrhagic stroke during pregnancy and maternity reported by Beijing Tiantan Hospital of Capital Medical University was 53/100,000 deliveries, among which hemorrhage due to intracranial arteriovenous malformation (AVM) accounted for 17%, aneurysm and moyamoya disease each accounted for 16%^[6]The high proportion of hemorrhagic stroke during pregnancy and delivery may be related to the high attendance rate of stroke, intracranial AVM, aneurysm and moyamoya disease in this hospital. Jaigobin and Silver^[3]Fifty 700 maternal findings were summarized, 13 (2.5/10 000) developed cerebral hemorrhage, of which 7 were SAH (1.4/10 000), 6 were intracerebral hemorrhage and 3 died, with a case mortality rate of 23%. In the United States, the hospitalization rate of stroke during pregnancy and puerperium showed an increasing trend from 1994 to 2007^[7]。 Of course, some studies suggest that pregnancy and childbirth do not increase the risk of SAH^[8]。 Dias and sekhar^[9]It was reported that the maternal mortality rate of hemorrhagic intracranial aneurysms and AVM treated conservatively and surgically was 35% in maternity and 15% in fetus. Therefore, SAH during pregnancy and maternity should be paid attention to.

At present, the defined risk factors for carotid stenosis include age, sex, race, smoking, inflammatory reaction, drug abuse, lipid metabolism disorder, hypertension, diabetes, metabolic syndrome and genetics. Randomized clinical trials have shown that both carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) can reduce the probability of stroke in patients with carotid stenosis^[1]。 However, there is still a lack of authoritative clinical trial guidance for the selection criteria of the two procedures. Although large-scale clinical trials in North America and Europe suggest that the safety of choosing CAS may be higher in young patients with carotid stenosis^[2,3]But other clinical factors are still lacking in randomized clinical trial analysis. And some important populations, such as patients with postoperative restenosis, are often excluded from clinical trials^[4]。 Therefore, the comprehensive assessment of patients' risk factors before CEA and CAS are implemented is particularly important. By reviewing the relevant literature at home and abroad, we analyzed the association of common risk factors before surgery and the risk of death and stroke during the perioperative period of CAS and CEA, so as to provide a reference for the choice of surgical methods for patients with carotid artery stenosis.