2016年 · 第32卷第01期

With the start of "brain research programs" and the advent of "precision medicine" era in various countries around the world, how to develop the brain tumor specialty, which plays an important role in neurosurgery, is a problem that experts and scholars engaged in brain oncology have been deeply discussing and paying attention to. In recent years, although the overall level of neurosurgery in China has made great progress, it cannot be ignored that the level of brain tumor surgery and comprehensive treatment in various regions is still very uneven. The national collaborative research network for brain tumors has not yet been established, and the clinical transformation of some new diagnosis and treatment technologies needs to be strengthened urgently. Faced with these problems, how to do brain tumors in China? How to do it? At a time when opportunities and challenges coexist, it is most urgent to change this situation at the national level to "build platforms, collaborative innovation, win-win cooperation and project-driven professional development". As the leader of the brain tumor professional group of the Neurosurgery Branch of Chinese Medical Association, the future clinical diagnosis and treatment of brain tumors and translational medicine research are explained from the following aspects.

Primary trigeminal neuralgia is a type of paroxysmal facial pain, and familial cases have been reported rarely. Since the Department of Neurosurgery, General Hospital of Tianjin Medical University began to treat primary trigeminal neuralgia with microvascular decompression in 1999, the author diagnosed and treated a case of familial primary cranial nerve disease in 2013, and investigated a total of 3 cases of primary trigeminal neuralgia in three generations, of which 2 cases were treated with microvascular decompression, with satisfactory clinical results. The review literature is reported as follows.

Anterior communicating artery (ACoA) aneurysms account for about 30% of intracranial aneurysms, while the incidence of distal anterior cerebral artery aneurysms is relatively low, accounting for about 1.5% ~9% of intracranial aneurysms^[1]。 The local anatomy of the aneurysm in this site is complicated, the location is deep, the surgical exposure is difficult, and there are many surgical approaches. At present, the commonly used approaches are pterional approach, subfrontal approach, extra lateral approach, longitudinal fissure approach, frontal-base-longitudinal fissure approach, etc. From January 2012 to March 2015, the Tenth Affiliated Hospital of Guangxi Medical University clipped a total of 11 cases of anterior cerebral artery and ACoA aneurysms through frontal-longitudinal fissure approach. The results are reported below.

There are many types of intracranial tumors, and there are many corresponding treatment methods, among which radiotherapy is an important treatment method. With the gradual deepening of research on radiotherapy for intracranial tumors, many researchers have found that radiotherapy can cause many kinds of radiation damage. These radiation injuries are mainly reflected in the damage to nerve tissue and cerebrovascular system, among which the damage to cerebrovascular system is divided into ischemic damage and hemorrhagic damage^[1]。 Intracranial aneurysms associated with radiotherapy are a rare phenomenon in hemorrhagic lesions^[2]There are few related reports at home and abroad. This article reviewed three patients with intracranial aneurysms due to radiotherapy of intracranial tumors admitted to the neurosurgery department of Tianjin Huanhu Hospital, and analyzed their clinical data and imaging characteristics.

primary non-Hodgkin's lymphoma of bone is a rare bone tumor that occurs in the bone marrow without regional lymph nodes and visceral invasion. Its incidence rate only accounts for 1% ~2% of all malignant lymphomas and 3% ~5% of all lymphomas outside lymph nodes. The most common sites are the long bones of lower limbs and pelvis (50%), long bones of upper limbs (20%), spine, ribs, etc. Cases of skull as the first site are very rare. In 1983, foreign scholars reported the first case of primary non-Hodgkin's lymphoma of the skull. Up to now, no more than 10 cases have been reported with complete case data in China^{[1,2,3,4,5,6,7]}No more than 30 cases were reported in English literature^[8,9]。 A child with primary non-Hodgkin's lymphoma of the skull was admitted to the Department of Neurosurgery of the First Affiliated Hospital of Guangdong Pharmaceutical University on June 23, 2015. The report is as follows.

This article reviews and analyzes nearly 2 000 papers involving the surgical treatment of acoustic neuroma, summarizes the contents of literature reports in different eras, and roughly divides the surgical treatment of acoustic neuroma in China into four stages.

Endovascular treatment of intracranial aneurysms has been developed for nearly 30 years. After the appearance of releasable coil, this method has gradually developed and matured, and has become an important method for the treatment of intracranial aneurysms^[1,2,3]。 However, for intracranial microaneurysms (maximum diameter ≤3 mm), endovascular treatment is difficult because of the catheter in place^[4]High intraoperative rupture rate^[5,6,7]And other issues have been controversial. In recent years, with the rapid development of interventional materials such as micro-catheters, micro-guide wires, soft or ultra-soft coils, and the application and popularization of three-dimensional digital subtraction angiogram (3D-DSA), balloon or stent-assisted coil tamponade technology, blood flow guidance devices and other technologies, the endovascular treatment technology has been further improved. Multiple studies have shown that endovascular treatment of microaneurysms is necessary, safe and effective^[8,9,10]。 However, due to the particularity of the treatment of intracranial microaneurysms, existing international studies of intracranial aneurysms such as the International Study of Unruptured Intracranial Aneurysms (ISUIA)^[11]Analysis of Endovascular Treatment of Unruptured Aneurysms (ATENA)^[12]International Aneurysmal Subarachnoid Hemorrhage Test (ISAT)^[13]No special studies on the treatment of microaneurysms have been conducted. At present, endovascular treatment of microaneurysms is mostly single-center, small-sample, retrospective analysis, but lacks the support of prospective, large-sample, controlled studies. Therefore, the endovascular treatment of intracranial microaneurysms is still controversial^[7,10,14,15]。 By summarizing the existing literature at home and abroad, the progress of endovascular treatment of intracranial microaneurysms is reviewed as follows.

Insular gliomas account for about 16% of all gliomas^[1]。 Due to its deep location and complex adjacent structure, insular glioma still has the characteristics of difficult total surgical resection, high incidence of postoperative neurological dysfunction and easy postoperative recurrence. Many scholars at home and abroad advocate total resection of tumor and comprehensive treatment while protecting neurological function to the greatest extent.

Because of the disease, injury and organ dysfunction caused by aging of human tissues and organs, there is a huge gap in clinical tissue and organ replacement therapy^[1,2,3]。 The research of biological artificial organs has always been a hot spot in regenerative medicine research, and has huge clinical application prospect. In order to achieve functional replacement of natural organs, two main end points need to be achieved: generation of the correct component cell types and establishment of a three-dimensional organization structure with physiological characteristics and functions, both of which are highly specific for the corresponding organs^[2,4]。 In recent years, there are multiple research and development strategies that have created a good start in this field, offering theoretical possibilities for transplanting bioartificial organs. At present, the main three strategies include: (1) whole organ decellularization and organ regeneration based on natural extracellular scaffolds that embody organ specificity^[5,6,7]； (2) Different cell types are self-assembled to form specific structures and finally organoids^[8,9,10]； (3) 3D Organ Printing and Directed Implantation of Desired Cell Types Based on Computer-Aided Matrix Scaffold Construction^[11,12,13]。 The research progress is summarized as follows.

High-grade glioma is a kind of malignant tumor with high degree, easy recurrence and poor prognosis. The results of surgery combined with postoperative radiotherapy and chemotherapy are not satisfactory. Bevacizumab, which targets vascular endothelial growth factor (VEGF), has the function of inhibiting blood vessel growth and has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of recurrent high-grade glioma. However, there are still different opinions on whether the combination of bevacizumab and other drugs and therapeutic modalities is effective in the first treatment of high-grade glioma, and whether there are adverse reactions that increase tumor aggressiveness. This article will make a summary on the above problems.

Dystonia is a group of clinical syndromes characterized by constant muscle contraction resulting in twisting, repetitive movements, or abnormal posture^[1]。 It can also be manifested as abnormal activity of muscle involvement in contraction during active movement and not related to the target movement. At present, more and more studies have found that deep brain stimulation (DBS) can achieve good curative effect on dystonia.

Glioma is the most common primary brain tumor in adults, accounting for about 80% of primary brain malignancies^[1]。 In recent years, despite the continuous improvement of surgery, radiotherapy, chemotherapy and other treatments, the prognosis of glioma patients is still very poor^[2,3]。 The median survival of patients with the most aggressive glioblastoma (WHO grade IV) was only 12 to 15 months^[4,5]。 In the past decade or so, short chain non-coding nucleic acids (microRNAs, miRNAs) have received obvious attention. Relevant studies have confirmed that miRNA can bind to the corresponding target mRNA and affect the proliferation, invasion and apoptosis of glioma cells^[5]。 Since Han et al.^[6]After the expression of long non-coding RNA (lncRNA) in glioma and normal brain tissue was confirmed by gene chip for the first time in 2012, the relationship between lncRNA and glioma has gradually gained the attention of researchers. Current studies have shown that lncRNA is closely related to the occurrence, development and differentiation of glioma^[7]。 This article reviews the relationship between lncRNA and glioma.

With the development of transportation, construction, sports and other undertakings in recent years, the incidence of craniocerebral injury is gradually increasing. The patients mainly show that the abnormal increase of intracranial pressure caused by edema, hematoma, etc. leads to brain parenchyma injury and neurological injury^[1]。 The impairment of neurological function directly affects the movement, language, thinking and other functions of patients, among which brain cognitive impairment is the most common, mainly in learning, memory, language, thinking, spirit and emotional function disorders^[2]So that the patient cannot return to normal social life. For the treatment of craniocerebral trauma, especially for patients with severe craniocerebral trauma and cerebral hernia, decompressive craniectomy is often the only surgical treatment^[3]。 Domestic experts have also confirmed through prospective studies of large cases of craniocerebral trauma that large bone flap decompression can fully compensate the volume of cranial cavity, relieve the compression of brain stem caused by cerebral hernia, and effectively protect brain function^[4]。 However, the skull defects caused by decompression also bring a series of complications, especially the cognitive effects, which are also attracting increasing attention^[2]。 The author reviewed the correlation between cognitive impairment of brain after craniocerebral injury and skull defect after decompressive craniocerebral craniectomy.