2015年 · 第31卷第07期

Zhang Jianning is a professor of neurosurgery, doctoral supervisor, General Hospital of Tianjin Medical University, an expert with special allowance from the State Council and a young and middle-aged expert with outstanding contributions from the Ministry of Health. He is currently the president of General Hospital of Tianjin Medical University, the director of Tianjin Institute of Neurology, the senior consultant of Montreal Institute of Neurology, Canada, the chairman of Neurosurgery Branch of Chinese Medical Association, the vice president of Neurosurgery Branch of Chinese Medical Physicians Association, the vice president of Tianjin Medical Association, the vice president of Tianjin Medical Physicians Association and the chairman of Tianjin Neurosurgery Society. At the same time, he also serves as the deputy editor-in-chief of Chinese Journal of Neurosurgery and Chinese Journal of Neuropsychiatric Disorders, and the editorial board of more than 10 other academic journals. He has been engaged in the medical teaching and research of neurosurgery for more than 30 years, and has completed more than 2,000 neurosurgical operations. He is good at microsurgical treatment of spinal diseases, cerebrovascular diseases and sellar tumors, and has been devoted to clinical and basic research of craniocerebral trauma treatment for many years. He has successively undertaken a number of national scientific research projects such as key projects of National Natural Science Foundation of China. He translated and co-edited many academic monographs, and published 241 academic papers as the first author and corresponding author, of which nearly 44 were included in SCI, with a cumulative impact factor of over 100 points.

The sieve plate is the weakest part of the anterior skull base, which is easily destroyed by tumors and forms cranio-nasal communicating tumors. If the involvement in the nasal cavity is less, it can be removed through the tumor channel formed by the anterior skull fossa floor. If the tumor in the nasal cavity is large, it is difficult to total resection in the first stage of conventional surgery^[1]。 From January 2011 to October 2014, the Department of Neurosurgery of the Second Affiliated Hospital of Nanchang University performed extended frontal-floor approach to remove 8 cases of anterior cranial-nasal communication tumors with satisfactory results. The report is as follows.

Hassoun et al.^[1]central neurocytomas (CNC) were first discovered in 1982 and described under electron microscopy as having neuronal characteristics. These rare tumors originate in the septum pellucidum, however their precise origin is unclear. CNC is a benign tumor with World Health Organization Grade II. The final diagnosis of CNC relies on immunohistochemistry and electron microscopy to confirm the neuronal characteristics of the tumor^[2]。 An accurate diagnosis is very important, and for most patients, complete removal of the tumor can cure the disease. However, some atypical CNCs have also been reported with atypical histological features and high mitotic activity, possibly with a poor prognosis and high recurrence rate^[3,4]。 Extraventricular CNC has typical features but poor prognosis. Radiation therapy may be effective in improving patient prognosis^[3,4]。 This article retrospectively analyzed 5 CNC patients who underwent surgical treatment in the neurosurgery department of our hospital between May 2010 and October 2013, and analyzed the clinical characteristics, histopathological examination and surgical treatment methods of tumors.

vertebrobasilar dolichoectasia (VBD) causes related symptoms due to abnormally dilated and tortuous blood vessels that directly compress the brainstem, nerve roots, and the posterior part of the third ventricle, and even causes hemodynamic changes, thrombosis and microembolism, resulting in posterior circulation ischemia symptoms. Some patients may form acute dissecting aneurysms and even cause subarachnoid hemorrhage^[1,2,3]。 The incidence of VBD is relatively low, the clinical symptoms are not specific, and it is easy to miss and misdiagnose. Now, 4 patients admitted to our department in the past 6 years are reported as follows.

vein of Galen aneurysm malformation is a vascular malformation originating from the venous reflux system of the choroid plexus. During the 6th to 11th week of embryonic development, the embryonic Markowski intermediate vein developed abnormally, forming a special vascular malformation with a single intermediate drainage vein and multiple arteriovenous fistulas on the vein wall^[1]。 Because of the impact of high-speed blood flow, the vein expands like a tumor and looks like an aneurysm, so in 1946 Jaeger named it Galen's venous aneurysm-like vascular malformation. Most of the patients are young and have complicated diseases. Before the introduction of endovascular therapy, its treatment is difficult and the mortality rate is high. From January 1995 to December 2013, 192 cases of vascular malformations of the central nervous system under 6 years old were treated in the Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Region, including 6 cases of Galen venous malformations, with satisfactory treatment results, which are reported as follows.

spontaneous intracranial hypotension (SIH) is a group of clinical syndromes characterized by postural headache and decreased cerebrospinal fluid pressure. To date, the etiology of SIH is unknown. At present, it is generally believed that the pathogenesis of this disease is related to the following factors: (1) cerebrospinal fluid leakage caused by small tears of cerebral (spinal) membranes. At present, most scholars still believe that cerebrospinal fluid leakage is the main cause of SIH. It has been reported in the literature that patients with SIH are often complicated with thyroid dysfunction, and thyroxine is considered to have the function of maintaining normal connective tissue structure. Patients with thyroid dysfunction are often complicated with connective tissue disease, so patients with SIH may have congenital or acquired rupture of meningeal diverticulum^[1]。 Takahashi et al.^[2]The presence of cerebrospinal fluid leakage in patients with SIH was confirmed using radionuclide cisternography and spinal cord scanning techniques. (2) Decreased secretion of cerebrospinal fluid. Mental stimulation, fatigue, lack of sleep, respiratory infection and other factors can affect the hypothalamus-pituitary-adrenocortical system and the sympathetic-catecholamine system in the brain. Through neuroimmune and neuroendocrine effects, the contraction and diastolic function of choroid plexus vessels are disordered, resulting in temporary dysfunction of choroid plexus, thus reducing cerebrospinal fluid secretion.

Brain trauma is an important cause of disability and death among young adults in China. A considerable number of patients with severe brain trauma are difficult to return to society, which brings a huge economic burden to society^[1]。 Throughout the 150-year treatment history of traumatic brain injury, although the mortality rate of traumatic brain injury has decreased significantly, the mortality rate of severe traumatic brain injury still maintains at about 35%^[2]All clinical drug treatment trials for brain trauma have ended in failure, and their current treatment level has entered a "bottleneck period"^[3]。 According to incomplete WHO statistics, brain trauma will surpass cancer and cardiovascular and cerebrovascular diseases as the leading cause of death in the world in 2020^[4]。 In recent years, scholars have paid more and more attention to nutritional support in the acute phase of traumatic brain injury patients. Reasonable early nutritional support may be an effective method to improve the treatment level of traumatic brain injury patients^[5]。

Cushing's disease is a series of substance metabolism disorders and pathological changes caused by the proliferation of pituitary adrenocorticotrophic hormone (ACTH) adenomas or ACTH cells, which leads to excessive secretion of ACTH, which causes adrenal cortical proliferation and produces hypercortisolism. It is clinically manifested as Cushing's syndrome. If not effectively treated, Cushing's disease has a very high rate of disability and mortality^[1]。 Transsphenoidal surgical resection is the first choice for Cushing's disease. However, since most pituitary ACTH adenomas are microadenomas, and some pituitary MRI examinations of Cushing's disease do not have clear tumors, it is difficult to operate totally, and the postoperative remission rate is low. Long-term follow-up found that the postoperative recurrence rate can be as high as 25% ~46%^[2,3,4]。 Although radiotherapy can alleviate symptoms in 50% to 60% of relapsed patients, the safety of radiotherapy has gradually caused much controversy because of its slow onset and often leading to the risk of hypopituitary function and secondary brain tumors^[5]。 Bilateral adrenalectomy may be one of the most effective methods to relieve hypercortisolemia in patients with recurrent Cushing's disease, but it is not widely used because it requires permanent hormone replacement therapy after surgery and often leads to serious complications such as Nelson's syndrome^[6]。

medulloblastoma (MB) is the most common central nervous system tumor in children. The incidence rate in men is 1.5 times that in women, and the prognosis is extremely poor. Traditional classification of MB was classified into classical type, connective tissue-promoting type, extensive nodular type, large cell type and anaplastic type, mainly according to its histopathological characteristics^[1]。 The traditional histopathological classification of MB has great limitations in guiding clinical treatment and suggesting clinical prognosis^[2,3]。 At present, the understanding of MB has entered the molecular field. Each molecular subtype has different gene mutation, epigenetic and cytogenetic characteristics, and is also different in histology, epidemiology and clinical prognosis^[4,5,6,7,8]。 Some molecular markers related to MB survival prognosis have been discovered one after another^[9,10]。 In this paper, the research progress of MB in molecular biology related to molecular typing and prognostic indexes in recent years is reviewed.

Spontaneous atlantoaxial dislocation can be caused by a variety of causes, mainly secondary to rheumatoid arthritis and other lesions in European and American countries, while congenital dysplasia is the main cause in China. With the development of 3D CT and other imaging technologies, people realize that the morphological distortion of the lateral atlantoaxial joint will make it lose its normal load-bearing function, and over time, atlantoaxial dislocation will appear, which will cause the odontoid process to compress the brainstem and upper cervical spinal cord, resulting in clinical symptoms. For the treatment of this disease, through the efforts of several generations, the traditional treatment scheme of oral (nasal) odontoidectomy and decompression and posterior internal fixation and bone grafting fusion has been formed, and certain therapeutic effects have been obtained^[1,2,3]。 However, in the past 10 years, the internal fixation technology in this field has advanced by leaps and bounds, and remarkable progress has been made. The purpose of this article is to review these internal fixation techniques and discuss their indications.

affective disorder (AD) is a common clinical symptom and complication of brain tumor patients, mainly including depression, mania, mania-depression, anxiety disorder, etc. The clinical manifestations include neuropsychological abnormalities such as agitation, impulsivity, psychotic symptoms, intellectual and cognitive impairment, personality changes and affective symptoms^[1]。 Patients with brain tumors with neurological deficit are often accompanied by secondary affective disorders in a long course of disease, and clinically, anxiety and depression disorders are more common. The incidence of depression in glioma patients ranges from 5% to 93%, and 10% to 15% of them commit suicide due to severe depression^[2,3]。 Current research suggests that some neurobiological transmitters and endocrine abnormalities in the body may be related to the occurrence of affective disorders in brain tumors. At the same time, the location of brain tumor, tumor type and pathological changes of brain tissue may also be involved in the occurrence of affective disorder. In this paper, the possible pathogenesis of affective disorder in brain tumors, the relationship between brain tumors, tumor types and neuroimaging changes are reviewed as follows.