2015年 · 第31卷第10期

Sepsis is a common complication of severe craniocerebral trauma. Both severe craniocerebral trauma and sepsis are common causes of systemic inflammatory response syndrome (SIRS). SIRS caused by both have similar clinical manifestations and are difficult to distinguish. Therefore, the early and effective differentiation of infectious and non-infectious SIRS is important for choosing correct and effective treatment and avoiding the abuse of antibiotics. The value of serum procalcitonin (PCT) in early diagnosis of severe craniocerebral trauma complicated with sepsis was analyzed.

From June 12th to 14th, 2015, the 3rd National Pediatric Neurosurgery Academic Conference, sponsored by Chinese Medical Association and jointly organized by Chongqing Medical Association, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine and Children's Hospital affiliated to Chongqing Medical University, was held in Chongqing. Professor Ma Jie of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine and Professor Qi Songtao of Southern Hospital of Southern Medical University served as the chairmen of the conference, Professor Feng Hua of Southwest Hospital of the Third Military Medical University and Professor Liang Ping of Children's Hospital affiliated to Chongqing Medical University served as the executive chairmen of the conference. At the same time, this conference hosted the 2015 World Pediatric Neurosurgery Continuing Education Course (ISPN Course), the 7th China Pediatric Neurosurgery Forum (CPNF), the 6th Shanghai International Neuroendoscopic Operation Training Course (SINEHOW) and the 2nd Chongqing Young Neurosurgery Physicians Forum.

Acromegaly is a chronic progressive endocrine disease with insidious onset. It is mostly caused by excessive secretion of growth hormone (GH) by pituitary tumors, and is characterized by hypertrophy of limbs and organs. According to the latest literature, the incidence of pituitary adenomas is 78~94/100,000, and acromegaly accounts for 12.5% of them^[1,2]。 Cardiovascular disease is a serious complication in patients with acromegaly, and it is the main cause of death in patients with acromegaly. Almost all patients with acromegaly with a course of more than 10 years will develop cardiovascular lesions, and the latter is the leading cause of death in acromegaly patients. About 80% of untreated acromegaly patients died of various cardiovascular complications before the age of 60. Heart disease caused by acromegaly, except for the involvement of other pathogenic factors, is called acromegaly cardiomyopathy^[3]。 In the 2006 American Heart Association (AHA) classification of cardiomyopathy, acrohypertrophic cardiomyopathy was classified as endocrine cardiomyopathy among secondary cardiomyopathies^[4]。

Pituitary prolactin adenoma is a kind of pituitary adenoma with high prolactin expression and hormone secretion, accounting for about 40% to 45% of adult pituitary functional adenomas, and is more common in female patients aged 20 to 50 years^[1]。 This article will review the diagnosis and treatment of pituitary prolactin adenoma before and after pregnancy.

Cushing's syndrome (CS) refers to a clinical syndrome characterized by hypercortisolemia caused by a variety of causes. Cushing's disease (CD) is the most common cause of CS^[1]Specifically refers to CS caused by excessive secretion of ACTH by adrenocorticotrophic hormone (ACTH) adenomas. The first choice of treatment for CD is transsphenoidal pituitary adenoma resection. At present, the remission rate of primary transsphenoidal approach can reach 65% ~96%, 17% ~35% of patients without remission after operation, and the postoperative recurrence rate is 2% ~20%^[2,3,4,5]。 Compared with the patients cured by the initial transsphenoid approach, the mortality rate of patients with postoperative tumor recurrence is significantly higher, so early detection of CD recurrence after operation and follow-up treatment are particularly critical.

Because of its characteristics of high mortality and short average survival, glioma has been a major problem in the treatment of malignant tumors of central nervous system. Current traditional therapies such as surgery and radiotherapy and chemotherapy have not significantly improved the prognosis of glioma patients^[1]。 In recent years, with the major breakthroughs in molecular biology and tumor immunology, as well as the increasing maturity of genetic engineering technology and cell engineering technology, molecular immunotherapy has made certain progress in the treatment of many malignant tumors. Among them, chimeric antigen receptor modified T cells (CAR-T cells) are the most active direction in the research of tumor immunotherapy at present. A few foreign research institutions have carried out the application of CAR-T cells to treat glioma clinical trials^[2]。 In this paper, the development, research status and prospect of CAR-T cells in immunotherapy of glioma are reviewed.

post-operative central nervous system infection (PCNSI) includes infections caused by bacteria, fungi and viruses, among which bacterial infections are the most common. Often acute onset, critical condition, serious neurological damage. After neurosurgery, due to trauma, edema, bleeding, stress and other reasons (non-infectious factors), meningitis fever, headache, meningeal irritation and other manifestations often occur, and even routine laboratory changes of blood and cerebrospinal fluid occur, which is difficult to distinguish from the clinical manifestations of bacterial meningitis. In addition, due to the use of intraoperative and preoperative prophylactic antibiotics, the positive rate of cerebrospinal fluid bacterial cultures commonly used to diagnose central nervous system infections is generally low. These problems make it difficult to unify the diagnostic criteria of PCNSI at present, which not only makes diagnosis difficult, but also affects the subsequent treatment decisions such as whether or when to start antibiotic treatment. Therefore, how to make a correct diagnosis early and take appropriate treatment measures is especially important for saving patients' lives and their neurological functions. We will summarize the risk factors of PCNSI (this article mainly refers to bacterial infection), the diagnosis of common PCNSI, and the determination of cerebrospinal fluid cytology, etiological indexes and biochemical markers of central nervous system infection after neurosurgery as follows, and propose a stepwise diagnostic scheme for bacterial infection of central nervous system after neurosurgery.

Postoperative infection, bleeding and pain are three major problems that need to be solved in the development of surgery, especially postoperative infection, which seriously threatens the life and health of patients. After the first introduction of aseptic techniques into surgical treatment by Hungarian physician Ignaz Semmelweis in 1847 and the discovery of penicillin by Alexander Fleming in 1928, the postoperative infection rate gradually decreased. However, in recent years, with the emergence of bacterial drug resistance in postoperative infection, nosocomial infection has gradually become prominent, which affects the safety of patients and increases the burden of patients. superbug is a topic of general concern.

At present, the situation of bacterial drug resistance in China is grim, and the resulting nosocomial infection problem is becoming increasingly serious, which is inseparable from the widespread abuse of antibacterial drugs in medical and health institutions. If this status quo is not changed, it will cause serious social harm, and even the treatment crisis of antimicrobial drugs will arise. At the same time, it will also bring a huge economic burden to patients and society^[1]。

A basic principle of functional neurosurgery is to relieve the patient's pain without causing serious complications that are unacceptable to the patient. One of the major problems troubling neurosurgeons who are just trying to perform microvascular decompression (MVD) is the occurrence of severe postoperative complications. Even for doctors with rich experience in MVD surgery, serious complications such as intraoperative petrous vein hemorrhage, brainstem perforating artery dissection, postoperative cerebellar and brainstem hemorrhage infarction can lead to catastrophic consequences, and postoperative facial paralysis, hearing impairment and other cranial nerve-related complications are not uncommon. The probability of posterior fossa decompression due to cerebellopontine angle (CPA) and hematoma of cerebellar hemisphere after MVD is about 0.3% ~2.5%, and about 1/3 of them die eventually; The total mortality rate of MVD was about 0.1% ~1% in addition to postoperative distant hemorrhage, cerebral infarction, hydrocephalus, intracranial infection, perioperative myocardial infarction, pulmonary embolism and other accidents^{[1,2,3,4,5,6]}Therefore, it is extremely important to assess the perioperative risk of MVD, take corresponding measures to improve the safety of MVD surgery and reduce the incidence of postoperative complications.