2015年 · 第31卷第05期

The biological behavior of brainstem cavernous malformations (BSCMs), especially the incidence and dominant hemorrhage rate of lesions calculated in combination with brainstem volume, is very different from that of cavernous malformations (CMs) in other sites. With the popularization of MRI, it has been found that many primary brainstem hemorrhage are caused by BSCMs. Early hemorrhage presents uniform hematoma signal or a little irregular low signal. After 1 to 6 weeks with the liquefaction and absorption of hematoma, it presents typical CMs characteristics under the background of high signal, while a few tiny BSCMs only appear as small nodules attached to the lateral wall of hematoma. The so-called dominant bleeding is mostly manifested as dizziness, vomiting, numbness of limbs or mobility disorders, facial paralysis, swallowing or dysphonia, etc. A few patients may have drowsiness, and very few may be life-threatening^[1]。 These symptoms usually peak within a few days and gradually resolve for weeks thereafter, with sequelae that may be very mild but with a higher risk of re-bleeding, especially within 2 years of the previous bleeding. Some patients may have repeated bleeding in a short period of time, resulting in sustained or wave-like deterioration of neurological function. Some patients can heal themselves in the long term. These advances in understanding have mainly come from the experience of physicians, and there is still a lack of scientifically designed research on the natural history of BSCMs. At present, most scholars believe that the incidence of BSCMs accounts for 9% ~35% of all intracranial CMs, the annual bleeding rate is 0.5% ~6.0%, and the annual re-bleeding rate will increase significantly^[1]。

The surgery of bilateral multiple intracranial aneurysms is difficult and the probability of postoperative complications is high. At present, the treatment of multiple intracranial aneurysms is still controversial^[1]。 We analyzed the clinical data of 11 patients with bilateral multiple intracranial aneurysms clipped by unilateral approach in the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2012 and December 2013. The results are summarized as follows.

Hydrocephalus and arachnoid cyst in children are common diseases in neurosurgery. Lateral ventricular-peritoneal shunt or arachnoid cyst-peritoneal shunt is widely used in clinical treatment because of its simple operation, less trauma and definite effect. However, a serious complication-shunt dependent syndrome (SDS) may occur after shunt surgery, which can lead to a sharp deterioration of the condition and even irreversible neurological impairment. So far, there are few reports on SDS at home and abroad. Clinicians often don't know enough about its clinical manifestations and imaging features, and sometimes it is difficult to diagnose and treat SDS. For this reason, this article collects 5 patients with SDS admitted to the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2010 to March 2014, and summarizes their clinical manifestations, imaging features and treatment methods.

Chiari I malformation is a common congenital malformation in neurosurgery, and it is often complicated with syringomyelia. The choice of surgical method for such patients is still controversial. From July 2010 to December 2013, the Department of Neurosurgery, Provincial Hospital Affiliated to Anhui Medical University performed surgical treatment on 41 adult patients with Chiari Ⅰ malformation complicated with syringomyelia, and the curative results were satisfactory, which are reported below.

Acute subdural hematoma is caused by cerebral contusion, cerebral cortical arteriovenous hemorrhage and bridge vein rupture^[1]Surgery is a good treatment at present^[2]。 hemoglobin (Hb) was significantly higher in Tibetan plateau than in low altitude or plain area. The optimal concentration of Hb was 147 g/L^[3]While high Hb has obvious damage to multiple organs in the whole body, especially the nervous system^[4]。 The 115th Central Hospital of the People's Liberation Army is located in the plateau area. In this paper, 78 patients with acute subdural hematoma who underwent surgical treatment from January 2006 to December 2013 in the neurosurgery department of this hospital were selected to explore the influence and correlation of postoperative Hb on neurological recovery, which is reported as follows.

decompressive craniectomuy (DC) is an effective method for the treatment of patients with severe craniocerebral trauma and refractory intracranial hypertension^[1]。 Intraoperative controlled decompression can effectively reduce the incidence of intraoperative acute encephalocele and postoperative cerebral infarction^[2,3,4,5]。 From January 2012 to December 2013, 49 patients with severe craniocerebral trauma underwent emergency decompression craniectomy in our department, of which 24 patients underwent progressive controlled decompression with intracranial pressure (ICP) monitoring during the operation, and compared with patients undergoing conventional decompression craniectomy at the same time, which is reported below.

With the gradual popularization of endoscopic skull base surgery, the advantages of neuroendoscopy in skull base tumor surgery are gradually recognized by the industry^[1,2]。 Nowadays, neuroendoscopic surgery can not only solve the space-occupying lesions in the sella turcica, but also complete the resection of lesions from the ethmoid-sellar-slope and even the odontoid level in the anterior frontal sinus group. When the tumor invades the subdural or the surgical operation involves intraarachnoid operation, how to effectively repair the defective skull base dura to avoid the occurrence of postoperative cerebrospinal fluid leakage has always been the key to the success or failure of neuroendoscopic surgery. Traditional methods of muscle fat tamponade combined with bio-glue repair are not very effective^[3]。 From March 2012 to January 2014, our department adopted the internationally respected skull base attachment technique with pedicled nasal septal mucosal flap to repair the defective skull base^[4]。 In this paper, 15 typical cases were reviewed and summarized to explore the anatomy of the pedicled nasal septal mucosal flap under neuroendoscopy (the posterior branch of the sphenopalatine artery) and its application prospect in endoscopic skull base surgery.

extraventricular neurocytoma (EVN) is a rare intracranial tumor. In 2007, WHO classified neuroepithelial tumors into one category independently. After searching by Pubmed and Wanfang databases, nearly 300 cases have been reported worldwide. From January 2000 to January 2014, 9 cases of central neurocytoma were treated in the Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, including 3 cases of EVN. The diagnosis and treatment experience is reported as follows in combination with the literature review, aiming to further improve the understanding of this disease.

With the improvement of national requirements for biomedical innovation ability, carrying out high-level standardized clinical research and clinical trials is the main demand to ensure innovation ability. China has abundant case resources, and at present, there are an increasing number of clinical research projects independently designed or participating in international cooperation. How to improve the management level of large-scale clinical research and get international recognition is a major issue that we are facing. Clinical trials or clinical studies in China often fall into three categories: The first category is clinical studies sponsored, designed and managed by medical institutions supported by national government departments. This kind of research is mostly purely academic research, with the participation of sub-centers (hospitals). A third-party company, a contract research organization (CRO), is typically requested to assist in project management. The second category is clinical trials managed by pharmacological bases, which are initiated and supported by biomedical companies, approved by the State Food and Drug Administration, and entrusted to medical institutions to design and manage. It also includes some clinical trials initiated abroad. The third category is horizontal joint projects, initiated by medical institutions or pharmaceutical companies, mostly academic research, such as post-marketing research on drugs. In view of the common problems in the process of clinical research project management, I put forward the following suggestions based on my experience in the clinical research management of the national "major new drug creation" project:

Microvascular decompression (MVD) has been widely used as a treatment for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, but the translated name of MVD is very confused in the Chinese literature. The most used Chinese name now is "microvascular decompression", which obviously comes from the literal translation of English, while "microvascular" in the Chinese name means something else, which does not have the same meaning as the English microvascular. MVD actually refers to neurovascular decompression under microscopic manipulation. So, is the responsible blood vessel of MVD microvessel? Obviously not!

Brain stereotactic technique is a common neurosurgical technique that uses stereotactic principle to accurately locate intracranial structures in space. It is also the basic technique of deep brain electrical stimulation, intracranial space-occupying biopsy, stereotactic hematoma aspiration, etc. It has become one of the most important locating methods in functional neurosurgery^{[1,2,3,4,5,6,7,8,9]}。 In recent years, foreign scholars have successfully carried out stereotactic hippocampal amygdala damage surgery by combining it with computer navigation technology, high-resolution magnetic resonance technology, intraoperative real-time magnetic resonance technology, radio frequency technology and damage prediction system, which has been used to treat temporal lobe epilepsy and other diseases, and obtained satisfactory therapeutic effect^[10,11,12]。 In this paper, the principle, application, therapeutic effect and complications of this technique are reviewed.

glioma-CpG island methylator phenotype (G-CIMP) is a newly proposed concept that characterizes the abnormal hypermethylation of the promoter CpG island in glioma from a genome-wide perspective. G-CIMP can be found in most WHO grade II and III gliomas and secondary glioblastomas, and has potential clinical application value for the prognosis and molecular classification of gliomas. The research progress of G-CIMP is reviewed.

The clinical manifestations of Parkinson's disease (PD) include motor symptoms and non-motor symptoms. In addition to traditional motor symptoms, dyskinesia caused by long-term administration of levodopa, namely drug-induced dyskinesia and levodopa-induced dyskinesia (LID), can also appear gradually with the progression of the disease. dyskinesia in PD patients can occur after long-term use of dopa preparations or can be generated by electrical stimulation of the implanted brain pacemaker, which is called stimulation-induced dyskinesia (SID). Patients with LID or SID accounted for 15% of all patients. It has been observed that most patients after DBS can still not completely stop taking levodopa. Therefore, a comprehensive review of LID and SID of PD patients is presented to provide medication or surgical recommendations for clinical patients with dyskinesia.

Papilledema is a type of disease in which the optic disc is passively swollen due to increased intracranial pressure. Increased intracranial pressure is a common clinicopathological syndrome of many craniocerebral diseases, and it is an important cause of death caused by neurosurgical diseases^[1]。 Intracranial tumor, craniocerebral trauma, intracranial infection, cerebrovascular disease and some unknown causes can lead to increased intracranial pressure. Because the treatment of intracranial hypertension is mainly aimed at the etiology, while the etiology and pathogenesis of idiopathic intracranial hypertension are still unclear, the treatment is different from other intracranial hypertension with clear etiology. This article only focuses on the progress of surgical treatment of papilledema caused by unexplained intracranial hypertension.

Carotid artery stenosis is a major risk factor for ischemic stroke^[1,2]Which can result in hypoperfusion cerebral infarction or arterial-arterial embolic cerebral infarction^[3]And the risk of ipsilateral stroke increases with the degree of internal carotid artery stenosis^[4,5]。 carotid artery stenting (CAS) has been developed with its minimally invasive advantages^[6]。