2015年 · 第31卷第09期

chronic subdural hematoma (CSDH) is a common disease in neurosurgery, accounting for about 10% of all kinds of intracranial hematoma, and it occurs in the elderly. Once symptoms of brain compression appear, surgery should be performed^[1]。 Drilling, irrigation and drainage is generally recognized as the first choice for the treatment of CSDH, but the recurrence rate of 3% ~37% is still reported in literature^[2]Among them, the recurrence rate of hematoma after septal CSDH is relatively high. From June 2011 to August 2013, 26 cases of CSDH were treated with soft neuroendoscopy in the Department of Neurosurgery, Beijing Shijitan Hospital affiliated to Capital Medical University, with satisfactory clinical results, which are reported below.

Chiari malformation is a congenital malformation of the craniocervical junction, clinically characterized by hernia of the cerebellar tonsil into the foramen magnum, with or without syringomyelia^[1,2]。 Atlas-occipital decompression surgery to relieve the compression of foramen magnum and cervical spine on cerebellum, brainstem, spinal cord, fourth ventricle and other nerve tissues is the main treatment method^[3]。 From March 2013 to March 2015, six patients with symptomatic Chiari type I malformation were treated in the Department of Neurosurgery of Tianjin Huanhu Hospital. Neuroendoscopy combined with intraoperative ultrasound technique was used for atlantooccipital decompression, and the results were good. The report is as follows.

Compared with craniotomy, stereotactic technique has the advantage of accurate positioning, and neuroendoscopic technique can perform surgical manipulation on the lesion under the condition of direct vision of the lesion area. The characteristics of the two technologies make them quickly popularized and applied in clinical practice. However, the use of the above two techniques independently also has their own limitations. Stereotactic surgery cannot look directly at the puncture channel during the positioning of puncture, and its blindness makes it easy to damage blood vessels during puncture, resulting in bleeding, and the bleeding is difficult to detect and stop^[1]； Neuroendoscopic technique lacks precise positioning, and the brain tissue may be damaged by finding the location of the lesion during operation. In order to overcome the limitations of the two technologies, the Second Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University began to absorb the experience of many parties since 2009, and after repeated discussion and research, the two technologies were combined into one, and dozens of cases of intracranial micro-lesions were successfully completed. Treatment, truly realizing the minimally invasive concept of neurosurgery. Among them, 7 cases of intracranial cavernous malformation (CM) were treated with this technique, and the curative effect was satisfactory.

Intracranial aneurysms are a common disease with an incidence of approximately 2% in adults^[1]Among them, multiple aneurysms account for about 25% to 30%^[2]。 Aneurysm rupture is the most common cause of subarachnoid hemorrhage (SAH), and the mortality and disability rate can be as high as 1/3 after first rupture hemorrhage^[3]。 Although the fatality rate of SAH has decreased with the improvement of medical level, the research on the risk factors affecting aneurysm rupture has been a hot spot in recent years. The risk factors affecting the rupture of multiple intracranial aneurysms are analyzed in this paper as follows.

Frontal and temporal lobe epilepsy is the most common refractory epilepsy in adults. At present, the main surgical treatment methods of frontal and temporal lobe epilepsy are epileptogenic resection and lobectomy. However, these surgical methods often have some complications, such as: brain tissue displacement, subdural effusion, oculomotor nerve paralysis, etc^[1]。 From January 2013 to June 2014, the Department of Neurosurgery of Tianjin Huanhu Hospital treated 7 patients with refractory frontal and temporal lobe epilepsy with prefrontal or anterior temporal lobe dissection, and achieved good therapeutic results, which are reported below.

Romani et al.^[1,2,3]Based on the pterional approach, a modified approach that is simpler and faster than the standard pterional approach has been developed, which they call the "lateral supraorbital approach" (LSO). LSO is more frontal than the pterional approach, which essentially utilizes the skull base space in front of the lateral fissure and on the subfrontal lateral side^[4]。 This method is simple, rapid and less invasive, and can replace the classical pterional approach pioneered and popularized by Professor Yasargil to treat anterior fossa floor, sellar region and suprasellar tumors, anterior circulation aneurysms and other lesions. In order to give full play to the advantages of LSO approach and carry out this approach quickly and well, the Neurosurgery Department of Qilu Hospital of Shandong University introduced the concept of standard operation procedure (SOP), which fully learned from Romani et al^[1,2,3]The characteristics of LSO approach, combined with the skinless wallet cranial opening and closing technology, according to the characteristics of temporal muscle and hairline in Chinese people, and based on the existing domestic conditions, the LSO hemless rapid cranial opening and closing technology has been carried out since 2011, and the SOP of this approach has been preliminarily formulated and practiced (Figure 1), the SOP and advantages of this approach are reported below.

At present, anti-epileptic drugs are still the first choice for epilepsy treatment, but 30% ~40% of patients eventually develop into drug-refractory epilepsy due to unsatisfactory seizure control or unable to tolerate the toxic side effects caused by the combined use of multiple anti-epileptic drugs^[1]。 Although some patients with drug-refractory epilepsy can undergo surgical treatment, the surgical outcome is not completely satisfactory, especially patients with neocortical epilepsy, which not only have poor surgical prognosis, but also often cause permanent neurological damage that is unpredictable before surgery. The presence of up to 30% of patients with drug-refractory epilepsy has prompted medical practitioners to look for new and ideal alternative treatments. At present, vagus nerve stimulation and reactive nerve electrical stimulation have been used in clinical treatment of drug-refractory epilepsy, with an effective rate of about 40% ~50%^[2,3]。 Some breakthroughs have been made in the research of deep brain electrical stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, local drug administration to epileptic foci, photosensitization and other techniques for controlling epilepsy in laboratory or clinical trials^{[4,5,6,7,8,9]}。 In the past few decades, a large number of animal experiments and clinical studies in our laboratory and other research institutions have proved that local hypothermia not only can quickly terminate epileptic seizures, but also has the advantages of reversible effect on cortical function and protective effect on brain tissue, thus showing the broad application prospect of local hypothermia technology in the field of treatment of refractory epilepsy^{[10,11,12,13,14]}。 In this paper, the experimental research and clinical application of local hypothermia in the treatment of epilepsy, the mechanism of hypothermia inhibiting epilepsy, the effect of hypothermia on brain function, its application prospect and challenges are reviewed.

deep brain stimulation (DBS) refers to electrical stimulation of specific parts of the deep brain to achieve the purpose of treating or alleviating diseases or disorders related to the nervous system. DBS has the advantages of good selectivity, clear target, minimally invasive, adjustable and reversible, and has been successfully used in the relief and treatment of Parkinson's disease, dystonia, major depression, alcohol/drug addiction and other diseases^[1,2]。 For different neurological diseases, different deep functional areas of the brain need to be stimulated, and the precise selection of stimulation position and precise implantation of stimulation electrodes directly determine the therapeutic effect of DBS. Stimulation of non-treated areas may cause dysarthria, epilepsy, dyskinesia, cognitive, emotional changes, limb dysfunction and other adverse effects. In addition, with the rapid development of closed-loop DBS technology and the synchronous regulation of multifunctional symptoms such as disease movement and cognition, higher requirements are put forward for the accurate positioning of stimulation electrodes and even contacts and the fine detection of functional areas.

Craniopharyngioma is an embryonic benign tumor, which occurs in the sellar region and often involves important structures such as hypothalamus, pituitary stem and optic chiasm. Surgical resection is the main treatment for craniopharyngioma at present. Postoperative radiotherapy and chemotherapy can improve the clinical symptoms and prognosis of patients. Because the tumor is closely related to the surrounding structures, it is difficult to surgically resect, especially the craniopharyngioma in the third ventricle. The position of the third ventricle is deep and close to important structures such as hypothalamus and Willis ring. Therefore, it is an important task for neurosurgeons to protect the surrounding structures from damage while completely excising the craniopharyngioma in the third ventricle as much as possible. Simple craniopharyngioma in the third ventricle is different from other craniopharyngiomas in the sellar region in origin, clinical manifestation, imaging and surgical methods because of its special location, and at the same time, it needs to meet several conditions such as intact third ventricle floor, obvious suprasellar cistern, normal pituitary stem and sella turcica without obvious abnormalities^[1,2,3]。

indocyanine green (ICG) is a near infrared fluorescent tricarbocyanine green dye with maximum absorption wavelength and maximum fluorescence wavelength of 805 nm and 835 nm, respectively. After ICG is injected intravenously into the human body, it combines with globulin in blood and exists in blood vessels. Under near-infrared light source and fluorescence camera, it can emit fluorescence to develop blood vessels containing ICG, and finally is excreted after liver degradation. The first application of fluorescence imaging in neurosurgery appeared in 1967^[1]。 Since then, with the advent of surgical microscopes displaying indocyanine green video angiography (ICGVA), ICGVA has been widely used in neurosurgery. This article summarizes the current application of ICGVA in neurosurgery, and discusses its advantages and disadvantages.