2015年 · 第31卷第11期

Hydrocephalus is a frequent and common disease in neurosurgery, which can be primary or secondary to other intracranial diseases. When intracranial tumors and other diseases are complicated with hydrocephalus or are expected to be complicated with hydrocephalus, doctors should consider the treatment strategy of hydrocephalus when formulating the treatment plan. The following introduces the author's experience in the treatment of several secondary hydrocephalus for colleagues' reference.

Grade I: Total tumor resection, and the dura mater and skull involved in the tumor are removed;

Endovascular therapy has become one of the main therapeutic methods for intracranial aneurysms, but large and huge intracranial aneurysms are still difficult to treat, and the complexity of operation technique and recurrence are the main problems faced at present^[1]。 In recent years, blood flow guiding devices have been applied in the treatment of large wide-necked intracranial aneurysms with satisfactory therapeutic results^[2]。 Tubridge stent is a domestic blood flow guiding device with independent intellectual property rights, which has the characteristics of low porosity and high metal coverage^[3]。 From March to October 2013, 7 cases of intracranial large and giant wide-neck aneurysms were treated with Tubridge stent in the Department of Neurosurgery of Shenyang Military Region General Hospital, which are reported below.

Hypertensive cerebral hemorrhage refers to non-traumatic hemorrhage in the brain parenchyma. It is a common disease and frequently occurring disease, accounting for 10% to 30% of all strokes. How to improve the quality of life of patients after illness, carry out effective disease assessment and prognosis judgment is an urgent problem for clinicians. Previous studies have found that detection of IL-1 β and IL-6 can be used to judge the prognosis of craniocerebral injury^[1]。 This study will investigate the changes of IL-1 β and IL-6 in plasma and cerebrospinal fluid (CSF) and their application value in the evaluation of cerebral hemorrhage.

Among the 30 patients in this group, 1 case died due to diffuse brain swelling after operation, and 29 cases survived. CT reexamination was performed 1~4 weeks after operation. Among them, 25 patients' ventricles returned to normal, and their symptoms disappeared or improved significantly; The ventricles of 4 patients were reduced, and the symptoms were well controlled. All 29 patients were followed up for 6 months to 2 years, of which: 1 died 6 months after discharge because of the ineffective rescue of other diseases; The survival time of 28 patients was>2 years. Among the surviving patients, 23 cases had complete remission of hydrocephalus symptoms, 4 cases had no obvious remission of symptoms, and 1 case had vegetative survival.

The incidence rate of chordoma ranged from 0.51 to 8 per 1 million, and the prevalence rate was less than 1/100,000^[1]。 Most of the studies on chordoma are retrospective clinical case reports, with few data from phase II clinical studies and few reports from phase III clinical studies. 10 years ago, most skull base chordomas were considered difficult to remove completely^[2]The total resection rate of chordoma has reached 52% (26/50) recently and 80% (8/10) after 2011^[3]。 In 2013, the European Society for Medical Oncology (ESMO) updated clinical guidelines for the treatment of sarcomas, including chordomas; In addition, under the advocacy and funding of the Chordoma Foundation (CF), more than 40 experts in related fields from the surrounding Atlantic countries reached a consensus and wrote opinions on the diagnosis, classification and treatment of Chordoma for the first time. The evidence level was classified as I ~ V according to the American Public Health Management Grading System of the American Society of Infectious Diseases, and the chordomas in skull base, spine and sacrum were discussed respectively^[1]。 This article intends to interpret the key points of skull base chordoma, and combined with the Expert Consensus on Clinical Application Technology of Skull Base Endoscopy in Chinese Neurosurgery (2014 Edition)^[4]and National Comprehensive Cancer Network (NCCN) 2015 Clinical Practice Guidelines for Bone Tumors (1st Edition)^[5]This discussion aims to help neurosurgeons improve their understanding of skull base chordoma, so as to promote standardized treatment and ultimately benefit patients.

diffuse intrinsic pontine glioma (DIPG) is a type of brainstem glioma. DIPG is characterized by high grade, local invasion and poor prognosis. It occurs in children aged 5~9 years^[1]。 There are about 150 cases a year in the United States and about 30 in the United Kingdom, with the same incidence rates for men and women. DIPG is not uncommon in outpatient clinics in China, but the incidence of DIPG cannot be statistically determined because there are very few people performing surgery in income wards. Brainstem gliomas are classified according to MRI imaging findings into the following growth types: diffuse endophytic, localized, dorsal exophytic and cervical bulbar. Among the four types, DIPG is the most malignant and aggressive, while the last three types are mostly low-grade malignant. This article will briefly review the progress in the diagnosis and treatment of DIPG in recent years.

The incidence of epilepsy after craniocerebral surgery is about 3% ~40%, among which the incidence of supratentorial surgery is 3% ~37%, and the incidence of craniocerebral trauma surgery is 6% ~53%^[1,2]。 Postoperative epileptic seizures may cause intracranial hemorrhage, cerebral edema, etc. However, due to various factors such as allergic reaction of antiepileptic drugs, liver damage, interaction with other drugs, blind use of antiepileptic drugs not only fails to reduce the incidence of epilepsy, but will cause harm to patients^[3,4,5,6]。 Therefore, the rational use of antiepileptic drugs during perioperative period is very important. In this paper, the selection of antiepileptic drugs during perioperative period in neurosurgery is reviewed in combination with the special situation of Chinese pharmaceutical preparations and the recent progress of domestic and foreign research.

Brain metastasis is the most common type of intracranial tumor, and it is also one of the important fatal and disabling factors of advanced malignant tumors^[1]。 10% ~40% of cancer patients will develop intracranial metastatic tumors during their disease development^[1]Its incidence is about 10 times that of primary intracranial tumors^[2]。 The common primary sites of brain metastases are lung (40% ~50%), breast (15% ~20%), skin (5% ~10%) and gastrointestinal tract (4% ~6%)^[3]。 Pathological and biological studies on the occurrence and development of brain metastases are also being carried out in many aspects. This paper reviews the pathological and biological characteristics of brain metastases from the aspects of genes, cell surface molecules, serum markers, brain parenchymal microenvironment and immunohistochemical characteristics related to tumor cells.

senescence marker protein 30 (SMP30) is an anti-aging molecule "discovered" in 1992 with a relative molecular mass of about 30,000, which was accurately measured to be 33,400^[1]。 However, several years later, researchers discovered that SMP30 is the same molecule as regucalcin discovered in 1978. At that time, they only realized that it can regulate intracellular calcium ion concentration and affect the activities of various calcium signaling enzymes^[1,2]。 Moreover, the researchers also found that SMP30 has gluconolactonase activity and is involved in the synthesis of vitamin C in some mammals^[1,3]。 The SMP30 gene is located on the X chromosome in most vertebrates^[1,4], its homologs have been found in at least 14 species and have a high degree of homology, suggesting that it may play some irreplaceable role in the evolutionary course of animal bodies^[1,5,6]。

focal cortical dysplasia (FCD) is a disease caused by neuronal migration disorder or cell proliferation disorder in the cerebral cortex. It is one of the most common causes of refractory epilepsy^[1]。 It is reported in the literature that in epilepsy surgery, FCD accounts for about 40% ~50% of children with epilepsy surgery and about 20% of adults with epilepsy surgery^[2]。 In recent years, with the development of imaging, brain electrophysiology, and pathophysiology, people have gained a deeper understanding of FCD. This article reviews the research progress of FCD and refractory epilepsy.