2015年 · 第31卷第02期

In recent years, with the rapid development of science and technology, the research results of brain science began to subvert the traditional concepts and understandings in the past. Although we have a clearer understanding of brainstem structure and function, and more in-depth research on tumorigenesis, brainstem glioma is still one of the refractory diseases in neurosurgery due to its particularity of anatomical structure and physiological function. Throughout the history of neurosurgery, brainstem gliomas have changed from being once recognized as "surgical restricted areas" to surgically explorable; From surgical biopsy to determine the pathological nature of the tumor to the efficacy of surgical treatment is gradually recognized; From the neurological protection of brainstem tumors to the value embodiment of comprehensive treatment, it has experienced the arduous course of continuous exploration, summarization and innovation by several generations for nearly a century.

Olfactory groove meningioma originates from the sieve plate and frontosphenoidal suture. It is a common skull base tumor, accounting for about 10% of intracranial meningiomas^[1]。 Because there are no obvious symptoms in the early stage of tumor growth, the volume of tumors found in clinical practice is often large. Tumors larger than 5 cm in diameter are called giant olfactory groove meningiomas, which are closely related to the optic path, hypothalamus, anterior cerebral artery and its branches, and are difficult to surgically resect^[2]。 From January 2006 to June 2014, 31 patients undergoing olfactory groove brain tumor were treated in the Department of Neurosurgery of Xinjiang Autonomous Region People's Hospital. The analysis report is as follows.

Most patients with cerebellopontine angle tumors can be resected by retrosigmoid approach. In the past, there were complications such as poor exposure, overexposure of sinuses or injury of venous sinuses, subcutaneous effusion or poor wound healing after surgery. How to avoid venous sinus injury, achieve good intraoperative exposure, and reduce the occurrence of postoperative complications often trouble us. From January 2010 to July 2012, our department used CT thin-section scan and three-dimensional reconstruction of body surface markers to locate transverse sinus and sigmoid sinus sulcus to guide suboccipital posterior sigmoid sinus approach craniotomy in 49 cases, with satisfactory results. The report is as follows.

primary melanocytic neoplasms (PMNs) of the central nervous system are a group of diffuse or localized benign or malignant tumors originating from the leptomeningeal^[1]。 Intraspinal PMN is clinically rare, Li Yong et al.^[2]Three cases were reported, accounting for only 0.34% of 870 cases of intraspinal tumors in the same period. The clinical incidence of PMN is low, and its clinical manifestations are often uncharacteristic. Like other spinal canal tumors in symptoms and signs, it is a symptom of spinal cord compression without obvious specific signs. In this paper, four cases of intraspinal PMN admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from November 2011 to June 2014 were clinically analyzed, and the reports are now as follows.

Brain abscess is a serious infection of the central nervous system. There are no guidelines for the treatment of brain abscesses, and many controversial issues need to be addressed, including the choice of surgical methods^[1]。 From January 1998 to February 2014, 76 patients with brain abscess were treated with stereotactic Ommaya capsule placement in the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University. Now, the clinical data of this surgical method were retrospectively analyzed to explore the clinical value of this surgical method.

diffuse intrinsic pontine glioma (DIPG) is a glioma whose tumor center is located in the pons. It grows invasively without obvious boundaries, and the pons is enlarged in an oval shape on magnetic resonance imaging. Brainstem glioma can occur in midbrain, pons, medulla oblongata and cervical spinal cord, and can be divided into endophytic, exophytic, localized and diffuse in morphology. The incidence of diffuse endophytic brainstem glioma accounts for 60% ~75% of brainstem tumors, and DIPG accounts for more than 90% of pons glioma^[1,2]。 The prevalent population of DIPG was children, the average age of diagnosis was 7-9 years, and there was no difference in the incidence of male and female^[1,2]。 The prognosis is extremely poor, usually death within 10 months after diagnosis, and only 10% of children survive for more than 2 years^[3,4]。 The factors leading to this poor prognosis include the complex anatomical structure of the brainstem, the important anatomical location and the diffuse endogenous growth of the tumor^[5]； Over the past two decades, no chemotherapy regimen has improved children's survival^[6]； Various radiotherapy regimens can only temporarily relieve children's symptoms, but do not change long-term survival^[6]； At present, due to the low rate of autopsy and biopsy and the difficulty of modeling, further understanding of the molecular biological characteristics of DIPG is not conducive to the research of new targeted therapies and preclinical experiments^[7]。

Hypothalamic hamartoma is a rare neurological disease characterized by ridiculous epilepsy and precocious puberty, often accompanied by cognitive dysfunction and developmental abnormalities. Its essence is ectopic normal nerve tissue, usually present at birth. However, the pathogenesis of its symptoms is still inconclusive. Because of the variable location of the growth of hypothalamic hamartoma, the treatment of hypothalamic hamartoma has been controversial. In recent years, some progress has been made in related research at home and abroad, which is summarized as follows.

Tumor is one of the important killers that threaten human health. At present, people have a relatively systematic and comprehensive understanding of the molecular mechanism of tumor occurrence and development. However, with the continuous deepening of tumor research, the changes of tumor genetic material^[1]The existing theories have not been sufficient to elucidate many new phenomena discovered in recent studies, such as endothelial cells maintaining the properties of cancer stem cells^[2]The biological effects of tumor microenvironment and tumor cell plasticity on tumors and their relationship can explain these new findings^[3,4,5,6,7]。 In this paper, the relationship between cell plasticity and tumor microenvironment and tumor stem cells will be summarized and discussed, and the molecular mechanism of hypoxia, metabolic changes and acidic environment regulating the plasticity changes of tumor cells will be emphasized.

From January 2009 to September 2013, a total of 25 transvascular clips were used in 17 cases of intracranial aneurysm clipping in the Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College. The application experience is reported below.

severe traumatic brain injury (sTBI) is the leading cause of death and disability among young people in developed and developing countries^[1]。 Although the treatment level has been greatly improved through the unremitting efforts of several generations of neurosurgeons, basic research and other related personnel, in China, due to the restrictions of geography, transportation, concept and professional level, the clinical treatment effect of sTBI in different medical units is quite different, especially in some key links such as pre-hospital emergency treatment, emergency treatment and intensive care quality control of sTBI patients, there is a lack of clinical standardization, standardization and scientificity. The author has been engaged in clinical treatment and research of sTBI for many years. The following is a few experiences and thoughts on the treatment of sTBI patients for peers' reference.

Comrade Huang Keqing, former director of neurosurgery in Fujian Provincial Hospital, died at 4: 16 am on December 22, 2014 at the age of 83 due to ineffective treatment.

From November 6th to 8th, 2014, the 13th National Academic Conference of Neurosurgery Branch of Chinese Medical Association was held in Xiamen. Qi Guoming, Vice President of Chinese Medical Association, Zhang Hui, Director of Academic Conference Affairs Department, leaders of Fujian Province and Xiamen Municipal Health Planning Commission and Medical Association, and leaders of Fujian Medical University Affiliated Hospital and Xiamen University Affiliated Hospital attended the meeting and delivered speeches. Academician Zhou Liangfu, Honorary Chairman of Neurosurgery Branch of Chinese Medical Association, Academician Zhao Jizong, Former Chairman, and Professor Zhou Dingbiao, Chairman, gathered with more than 3,000 neurosurgeons from all over the country to exchange experiences, share results and talk about the future.