2015年 · 第31卷第06期

Intracranial aneurysm is a disease that seriously endangers people's health. The incidence rate in healthy people can be as high as 4% ~6%. Although great progress has been made in diagnosis and treatment, once an aneurysm ruptures, its disability rate and mortality rate are still very high, and the total mortality rate of this disease is about 40% ~50%. Therefore, the early detection and treatment of intracranial aneurysm is very important for the prevention and treatment of cerebrovascular disease.

Traumatic extracranial internal carotid artery pseudoaneurysm is a serious complication of head and neck trauma, which is often life-threatening due to its rupture and bleeding, and can also lead to thrombosis and ischemic stroke^[1]。 Traditional surgical repair treatment has some difficulties, and ligation of diseased blood vessels often leads to obvious disability or even death^[2]。 Covered stent, as a new type of intravascular intervention material, can be placed into the blood vessel to cover the lesions and relatively abnormal migrating parts, and isolate the vascular lesions from the blood flow, which provides a new choice for the treatment of traumatic extracranial internal carotid artery pseudoaneurysm^[3]。 From January 2008 to December 2011, the Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Region, treated 5 cases of traumatic extracranial internal carotid artery pseudoaneurysm with covered stent placement, and the results were satisfactory.

Complex intracranial aneurysms are mainly aneurysms that are difficult to be treated by surgery due to special reasons such as growth site, growth mode, neck width and tumor size. Microsurgery is one of the main methods for treating complex intracranial aneurysms^[1]。 Due to the complexity of aneurysms, they remain a great challenge for neurosurgeons. In recent years, the application of intraoperative CT in neurosurgery has been reported^[2,3]。 This article summarizes the application of CT perfusion imaging (PCT) in the surgical treatment of 8 cases of complex intracranial aneurysm in the Department of Neurosurgery of the People's Liberation Army General Hospital from March 2012 to February 2013, and discusses the application value of intraoperative PCT in the surgery of complex intracranial aneurysm.

With the development of neurointerventional technology and material science, the role of stent in the treatment of intracranial wide-neck aneurysm has become more and more prominent, and intracranial self-expanding stent has played a pivotal role. At present, according to the different design of stent grid, there are mainly two types of self-expanding intracranial stents: one is an open grid stent; The other is a closed grid bracket.

posttraumatic acute diffuse brain swelling (PADBS) is the focus and difficulty of secondary brain damage after craniocerebral injury, which causes disability and fatality. For patients with intracranial pressure (ICP) stubbornly increased in PADBS, the American Association of Neurosurgeons recommends decompressive craniectomy when conventional treatment measures such as sedation, head elevation, hyperventilation, and dehydration are not effective. However, even if bilateral craniotomy is performed, encephalocele is still very likely to occur during the operation, which seriously affects the prognosis of patients. Patients with diffuse brain swelling who also underwent bilateral craniotomy had very different clinical outcomes. Some cases develop acute encephalocele, while others do not. The clinical data of 62 patients undergoing bilateral craniotomy with PADBS admitted to the Department of Neurosurgery of the 101st Hospital of the People's Liberation Army from January 2008 to January 2014 were retrospectively analyzed, with the aim of clarifying their risk factors and providing evidence for reducing intraoperative acute encephalocele.

Cerebral arteriovenous malformations (AVMs) are one of the common vascular diseases causing intracerebral hemorrhage, which consists of supply arteries, malformed vascular masses and drainage veins. Clinically, AVMs with malformed vascular mass ≤1 cm are called microarteriovenous malformations (mAVMs)^[1]Because the lesions are small and prone to bleeding leading to intracerebral hematoma, clinical diagnosis and treatment are quite difficult and challenging. This study retrospectively analyzed the clinical data of 13 patients with cerebral minor arteriovenous malformations admitted to our hospital from January 2008 to December 2013, which are reported below.

Standardized training of residents is an important part of medical students' graduate medical education, and it is of great significance to improve the level of basic medical services. It has been developed and standardized in developed countries for nearly a hundred years, and a consensus has been reached in China. In January 2014, seven departments including the National Health Planning Commission jointly presided over the issuance of the Guiding Opinions on the Standardized Training System of Residents and the corresponding document interpretation, which made basic institutional arrangements for the mode, content, work foundation, program framework, schedule and financial guarantee of standardized training of residents in China, and became the program to guide the training of residents nationwide. The training protocol for neurosurgeons is still under discussion. Stones from other mountains can be used to attack jade. Here, we briefly interpret the American Neurosurgery Resident Training Plan issued by the Accreditation Council for Graduate Medical Education (ACGME) in July 2013 for your reference. I hope to take the essence and combine the national conditions to establish a Chinese Neurosurgery Resident Training Standard that is more in line with the characteristics and requirements of China's Medical and health care.

Intracranial arteriovenous malformation (AVM) during pregnancy is a complicated disease. The prevalence of intracranial AVM is about 0.01% to 0.50%. Generally, symptoms occur between 20 and 40 years old, and most commonly in those over 30 years old. For women, it is the gestational age^[1]。

Intracranial cavernous malformation is a common disease in neurosurgery, with an incidence of 0.3% ~0.5%. It is more common in young and middle-aged patients aged 20~50 years. It can be divided into familial type and sporadic type. Most of the former are multiple lesions, while the latter are mostly single lesions. The main clinical manifestations of intracranial cavernous malformations are seizures and hemorrhage, but up to 21% of patients can still be asymptomatic^[1]。

Moyamoya disease is a vascular disease with unclear etiology and pathogenesis. It is characterized by chronic and progressive stenosis or even occlusion of the distal ends of bilateral internal carotid arteries, Willis ring, middle cerebral artery and proximal anterior cerebral artery in imaging, and collateral circulation formed by smoke-like small perforating arteries gradually formed at the base of the skull. Clinically, cerebral ischemia is the main manifestation, which may be accompanied by cerebral hemorrhage or other neurological symptoms such as brain dysfunction^[1]。 At present, its treatment is mainly surgical treatment for the purpose of increasing collateral circulation and improving cerebral blood supply. Superficial temporal artery-middle cerebral artery bypass grafting is the most widely used treatment plan, and has good therapeutic effect. Karasawa et al.^[2]17 patients with moyamoya disease were followed up for 1~4 years, and 13 patients with cerebral ischemia disappeared. Quest and Correll^[3]Fourteen patients with moyamoya disease were reported, and the symptoms of 11 patients improved significantly after operation. Superficial temporal artery-middle cerebral artery bypass surgery is a low-flow bypass surgery. In the past, it was thought that the incidence of cerebral hyperperfusion syndrome (CHS) with low-flow bypass surgery was very low. However, recent studies have found that the incidence of CHS after bypass surgery in patients with moyamoya disease is significantly higher than that in patients with non-moyamoya disease bypass or carotid endarterectomy^[4]。 Moreover, the clinical and imaging manifestations of CHS after bypass surgery in moyamoya disease are difficult to distinguish from those of cerebral ischemia, but the treatment options of the two are opposite, so the early detection and treatment of CHS after superficial temporal artery-middle cerebral artery bypass surgery in moyamoya disease is crucial. This article reviews the definition, epidemiology, etiology, clinical symptoms, imaging findings, treatment and prognosis of CHS after bypass surgery for moyamoya disease.

cerebral arteriovenous malformations (AVM) are the most common types of cerebral vascular malformations. AVM often starts with epilepsy or spontaneous cerebral hemorrhage, with high disability and mortality rates. Because of the complexity of vascular architecture and the difficulty of operation, AVM has been paid close attention by neurologists at home and abroad. At present, the main treatment methods of AVM include microsurgery, endovascular embolization and stereotactic radiosurgery (SRS). Each of the three methods has its own advantages and disadvantages, and for most AVMs, it is often impossible to use one method to achieve the goal of cure. With its minimally invasive characteristics, SRS is often used alone or in combination with other methods for deep small AVM. In recent years, rapid progress has been made, which is summarized as follows.

Peripheral nerve injury, especially the repair and reconstruction of long-segment thick nerve defects, is still a difficult problem in clinical medicine. Autologous nerve transplantation is the classic and preferred surgical method for repairing peripheral nerve defects, and it is also the "gold standard" for measuring various nerve bridging materials^[1]。 However, autologous transplantation can often cause nerve dysfunction in donor innervation area, and the source of autologous nerve available for transplantation is limited, the thickness of donor site nerve is not matched with that of recipient site nerve, and the length of donor site nerve is insufficient, which limits its clinical efficacy and indication scope. Therefore, new treatment strategies are urgently needed in clinic. According to the mechanism of peripheral nerve regeneration and the principle of biological histocompatibility, it has become an important research direction to explore the substitute of autologous nerve. Searching, inventing and combining various tissue materials that can be used for repair, preparing bioactive catheter and constructing tissue engineered nerve are the research hotspots in recent years^[2,3,4]。

optic pathway glioma (OPG) is an intracranial tumor that mainly occurs in childhood and grows on the visual pathway, accounting for about 1% of all intracranial tumors^[1,2], accounting for 3% to 5% of intracranial tumors in childhood^[3]。 About 75% of OPGs occur under the age of 10, and 90% can develop clinical symptoms before the age of 20^[4]。 At present, the incidence of the disease is not clear, but there is no obvious gender difference^[3]。 OPG can occur in any part of the visual pathway, such as the optic nerve, optic chiasm, or behind the optic chiasm, but it is more common to involve the optic chiasm structure. OPG occurs mostly scattered, but there are also OPGs associated with neurofibromatosis type 1 (NF1). NF1 is an autosomal genetic disease, and most NF1-related OPG patients can develop the disease before the age of 6 years^[5]Symptoms after 8 years of age are rare^[5,6,7]。 About 1/4 of OPGs involved only the optic nerve, and this was more common in NF1-related OPGs. In the total OPG population, the proportion of NF1-related OPG is about 30% ~58%^[8,9,10,11]。 NF1-related OPG is mostly localized to the optic nerve^[12]。 This disease is more common in low-grade tumors, and the common pathological types are pilocytic astrocytoma (WHO grade I), pilocytic myxoid astrocytoma (WHO grade II), fibroastrocytoma, etc. High-grade tumors are rare^[13]。 At present, the natural course of OPG is unknown, which affects the choice of treatment timing. The treatment methods of OPG include follow-up observation, chemotherapy, surgery and radiotherapy. This article reviews the current treatment modalities of OPG.