2015年 · 第31卷第03期

The origin of microvascular decompression (MVD) began with clinical studies for the surgical treatment of trigeminal neuralgia (TN). The results of decades of research have shown that the cerebellopontine angle (CPA) responsible vessels compress the root entry/exit zoon (REZ) of different cranial nerve roots, which can lead to the corresponding syndrome, namely neurovascular compression (NVC) syndrome. For patients with primary TN and glossopharyngeal neuralgia (GN) who can tolerate craniotomy, MVD has become the surgical treatment of choice. Combining MVD with CPA partial rhizotomy (PR) to improve the efficiency of operation and reduce the incidence of complications is the main direction of functional neurosurgeons.

Brain tumors are the most common solid tumors in children^[1]。 Posterior cranial fossa is a common site of all kinds of childhood tumors, accounting for 54% ~60% of childhood brain tumors, especially medulloblastoma, which can reach 20% of childhood central nervous system tumors^[2]。 The biological characteristics of medulloblastoma lead to a shorter course and a higher rate of misdiagnosis at first diagnosis^[3,4]。 At admission, they were often accompanied by symptoms of intracranial hypertension, cerebellar and cranial nerve damage, and were in a state of electrolyte disorder, malnutrition, and even unstable vital signs. Considering that Xinjiang is located in a frontier area, primary medical units do not have perfect conditions for examination and surgery, and most children need long-distance referral. Only head CT imaging data are available when admitted to hospital, and the general condition of children is already poor. For example, further comprehensive examination such as head enhanced MRI will make it difficult for younger children to cooperate, and there is a possibility of deterioration in the process of waiting for examination. Therefore, formulating a reasonable treatment plan plays an important role in the treatment of childhood medulloblastoma.

glomus jugular tumor (GJT) is a tumor derived from the accessory ganglion tissue of the bulb of the jugular vein. Treatment is very difficult because of the highly vascularized features, involvement of important neurovascular structures, and difficult to reach anatomical locations. At present, microsurgical resection, preoperative vascular embolization, radiotherapy and stereotactic radiosurgery are considered to be effective treatment methods^[1,2]。 Surgical resection is a radical treatment, but the treatment is risky and complications are high. In recent years, studies in multiple treatment centers have shown that gamma knife treatment has a definite effect and complications are rare. The author retrospectively analyzed the case data of 11 patients with GJT from the Second Hospital of Tianjin Medical University and 20 patients with GJT from September 1992 to September 2013, and combined with the long-term follow-up results, to explore the therapeutic effect of surgical treatment and gamma knife treatment on glomus jugular tumor.

Many hemorrhage often leads to difficult surgical resection and many postoperative complications during routine surgical resection of meningioma. From May 2011 to September 2013, our hospital used Habib 4X radiofrequency ablation technique to assist in the resection of 10 cases of larger meningiomas during surgery and achieved satisfactory results, which are reported below.

The craniocervical junction is a special area of skull base. Because of its deep location and the complex anatomical relationship of important vascular and nerve structures around it, surgical resection is very difficult. It has always been the key topic of clinical research in neurosurgery and skull base surgery. Since 1972 Hammon and Kempe^[1]The approach has been continuously improved since a procedure was proposed to expose vertebrobasilar aneurysms from the far-lateral side of the suboccipital side. Sea and Sekhar 1990^[2]Intradural lesions of lower slope and ventral medulla were successfully treated with this approach, and it was advocated that this approach should be popularized as a conventional approach for the treatment of lower slope lesions. With the development of microscopic neurosurgery, clinical research and application of this approach have been carried out in China^[3,4]。 From January 2011 to January 2013, 26 cases of ventral tumors in the craniocervical junction were treated with this approach in our hospital, and the clinical results were good, which are summarized as follows.

Intracranial aneurysm is a very dangerous, potential and fulminant cerebral hemorrhage disease with a high mortality and disability rate in clinic^[1]The hemorrhage after rupture is mostly manifested as subarachnoid hemorrhage (SAH). Choosing the proper surgical method and the best surgical time can not only reduce the mortality of ruptured aneurysm, but also minimize the neurological damage^[2]。 In this study, 62 cases of anterior circulation artery aneurysm treated by craniotomy and microsurgery from June 2010 to March 2012 were retrospectively analyzed. The corresponding results are reported below.

Sturge-Weber syndrome (SWS), also known as encephaotrigeminal angiomatosis or encephlofacial angiomatosis, is a rare and special cerebrovascular malformation, mainly characterized by congenital cerebral hemangioma and telangiectasia in the skin distribution area of the trigeminal nerve^[1]。 In recent years, it is considered to be a vascular abnormality of the skin, brain and eye. From March 2008 to March 2013, 4 patients with SWS were surgically treated in our hospital, which are reported in combination with the literature below.

dural arteriovenous fistula (DAVF) combined with blood flow-related aneurysms are rarely reported in the literature at home and abroad. This paper introduces the preliminary experience of two patients of this type who were treated by endovascular embolization combined with craniotomy in December 2013 in the Department of Neurosurgery of Shanghai Deji Hospital, and reviews the relevant literature.

Intracranial infection is a complication with high fatality and disability rate after neurosurgery. Early recognition and targeted treatment can significantly improve the prognosis. Due to the influence of stress, bleeding, implants and other factors, neurosurgery is often accompanied by fever, positive cervical resistance and other manifestations. It is difficult to distinguish between intracranial aseptic inflammatory reaction and infection. If all of them are treated as infection, it will lead to the abuse of antibacterial drugs and excessive medical treatment. Therefore, it is particularly important to select highly specific and highly sensitive indicators with differential significance for infection. procalcitonin (PCT) is a precursor substance of human calcitonin, which is relatively stable in vivo and in vitro.^[1]Since PCT was first reported as an early marker of bacterial infection, PCT has been applied to differential diagnosis, disease assessment and antibiotic efficacy evaluation of various bacterial, fungal or parasitic infectious diseases. The early diagnosis of postoperative intracranial infection is difficult due to the influence of surgery, blood-brain barrier and other factors, so the clinical significance of PCT deserves attention. This article reviews the biological characteristics of PCT and its clinical significance for postoperative intracranial infection.

Bow hunter's syndrome (BHS), also known as Bow hunter's stroke or rotating vertebral artery occlusion, is a rare clinical syndrome of vertebrobasilar insufficiency (VBI) caused by stenosis or occlusion of the vertebral artery caused by head turning within normal physiological ranges^[1,2,3,4]。 BHS can cause circulation disorders in perfusion areas such as brainstem, cerebellum, thalamus, occipital lobe, part of temporal lobe and upper spinal cord related to blood supply to the vertebrobasilar system, which are mainly manifested as dizziness, nystagmus, nausea, vomiting, paresthesia, Horner syndrome, dysphagia, loss of consciousness, ataxia, fall attack, diplopia and dysarthria^[1,5,6]。 DeKlevn and Versteegh, 1933;^[7]The correlation of head rotation with VBI is first reported. 1978, Sorensen^[8]This syndrome was first reported in one patient during archery movement. Earlier reports showed that vertebral artery occlusion associated with head rotation occurred most frequently in C_1～2^[9-10]Later, studies confirmed that the common location of rotating vertebral artery compression is C_1～2(50%) and C_5～7(50%)^[11]。 There are many causes of BHS, mainly caused by congenital stenosis, endogenous compression and exogenous compression^[6]。 The main diseases include: abnormal development and tortuosity of vertebral artery, congenital abnormalities of cervical vertebra, and dura stenosis of vertebral artery entering the cranial segment to compress vertebral artery; Atherosclerosis, arterial dissection, embolus; Traumatic instability (e.g. sports injury accidents), degenerative diseases (e.g. vertebral rigidity) and systemic diseases (e.g. rheumatoid arthritis), contraction of neck muscles, compression of tendons, ligaments, osteophytes and tumors, etc.^{[5,6,12,13,14,15,16,17]}。 Among them, exogenous factors are less common than endogenous factors. Due to the low incidence of BHS and few clinical cases reported, there is currently no clear diagnosis and treatment guideline^[18]。 At the same time, the etiology and pathogenesis of VBI are complex, and it is difficult to form standardized diagnosis and treatment standards. This article summarizes the development of diagnosis and treatment methods of BHS in recent years as follows, which provides theoretical basis for better clinical diagnosis criteria and treatment guidelines.

Intraoperative magnetic resonance (iMRI) technology has brought great help to neurosurgery, improved the effect and safety of surgery. This article reviews the development of iMRI technology and its application in neurosurgery.