2016年 · 第32卷第02期

From 2014 to 2015, endovascular treatment of acute ischemic stroke has undoubtedly become the biggest hot issue in the field of neurointervention. Twenty years ago, the landmark National Institute of Neurology and Stroke (NINDS) study proved that tissue plasminogen activator (tPA) can benefit stroke patients within 3 hours of onset than traditional drug therapy, thus opening a new era of acute stroke treatment^[1]。 How to restore the perfusion of cerebral blood flow as soon as possible is undoubtedly the key to treat acute stroke. The clinical application of the new stent-type thrombectomy device has greatly promoted the endovascular treatment of acute stroke with the advantages of high recanalization rate and low complication rate. However, early clinical studies have not demonstrated that thrombectomy can benefit patients. Based on the lessons learned from the above studies, some research centers have begun to design new studies in order to truly test the role of the latest endovascular therapy techniques in defining patients with acute large vessel occlusion. One of its core elements is the need to clarify the presence of vascular occlusion before randomization, and a strict time limit is set to ensure rapid recanalization of blood vessels. More importantly, the third generation thrombectomy device with relatively high recanalization rate is used. Including the multicenter randomized controlled clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands Endovascular Treatment of Acute Ischemic Stroke (MR CLEAN), the clinical trial of endovascular treatment of small focal stroke with proximal anterior circulation occlusion and emphasis on minimizing the time from CT to recanalization in Canada (ESCAPE), the clinical trial of prolonging the time from acute neurological deficit to intraarterial thrombolysis in Australia (EXTEND-IA), the North American trial of SolitaireTM endovascular mechanical thrombectomy as the primary endovascular treatment for acute ischemic stroke (SWIFT PRIME), and the randomized controlled study of stent thrombectomy and medical treatment within 8 hours in Spain (REVASCAT) have all demonstrated that the clinical outcome of combined endovascular thrombectomy is better than that of optimal drug treatment alone in patients with anterior circulation stroke with internal carotid artery or middle cerebral artery M1 segment involvement and symptoms of corresponding clinical defect^[2,3,4,5]。 It is precisely because of the Class I Grade A evidence provided by the above-mentioned multiple randomized controlled clinical trials (RCT) studies that it is confirmed that the best drug combined with arterial thrombectomy is superior to the best drug alone in patients with acute large vessel occlusion with anterior circulation lesions, making it an important turning point in the treatment of fatal stroke patients. The Guidelines for Endovascular Treatment of Acute Ischemic Stroke in China 2015 have raised the level of evidence-based medicine to Class I Level A evidence.

intracranial arachnoid cyst (IAC) is a common benign space-occupying lesion in children, with an incidence rate of about 2.6%^[1]。 The incidence of subdural effusion or hemorrhage caused by trauma or spontaneous rupture of arachnoid cysts is 2.3% ~6.0%^[2,3]Most of them require treatment due to symptoms of intracranial hypertension. This article retrospectively analyzed the clinical data of 15 children with subdural effusion or hemorrhage caused by IAC rupture admitted to the Department of Neurosurgery of Nanjing Children's Hospital affiliated to Nanjing Medical University from September 2009 to April 2014, and explored their etiology, classification, imaging features, treatment methods and prognosis.

Ischemic stroke is one of the major diseases that threaten the health of people in China. It has a high disability rate and mortality rate, and brings a heavy burden to society and families. Stenosis caused by carotid atherosclerosis is one of the important causes of ischemic stroke, and it is a high risk factor of stroke that can be eliminated by surgical intervention. carotid endarterectomy (CEA) is a treatment that prevents stroke due to plaque shedding by removing thickened atherosclerotic plaque in the carotid intima. From January 2014 to June 2015, 40 patients with carotid stenosis were treated with CEA in the Department of Neurosurgery, the Second Hospital of Hebei Medical University, and the surgical results were satisfactory.

Anterior choroidal artery aneurysms are aneurysms from the beginning of the anterior choroidal artery to the end of the internal carotid artery, accounting for 2% to 5% of intracranial aneurysms^[1]。 Anterior choroidal artery aneurysm is rare in clinical practice, and its rupture rate is 26.7%, which is significantly lower than that of posterior communicating artery aneurysm^[2]。 Anterior choroidal artery aneurysms mostly occur at the junction of anterior choroidal artery and internal carotid artery, and are often small in size. When they are enlarged, they can replace the anterior choroidal artery, but rarely compress the oculomotor nerve. When they are not ruptured, they mostly have no clinical symptoms. Its rupture can lead to subarachnoid hemorrhage and ventricular hemorrhage, and when the amount of hemorrhage is large, it can lead to cerebral hernia^[1]。

The pituitary stem is an important structure connecting the optic chiasm and the hypothalamus. The clinical manifestations of the lesions in this region are central diabetes insipidus, headache, visual impairment and endocrine symptoms. Common pituitary stem lesions are: thickening and thinning of pituitary stem or absence of pituitary stem. Pituitary stem width greater than 2 to 3 mm is considered pathological thickening^[1]； Absence of pituitary stem and ectopia of posterior pituitary gland are common in pituitary stem occlusion syndrome. The diagnosis and differential diagnosis of diseases related to pituitary stem lesions play a very important role in clinical diagnosis and treatment. This article intends to review the etiology, diagnosis, imaging manifestations, treatment and related research progress of diseases related to pituitary stem lesions.

How to predict the prognosis of craniocerebral injury early is an ancient topic, which has been mentioned in the literature as early as the ancient Egyptian era and Hippocrates era. Among them, Hippocrates has an epigram about the prognosis of craniocerebral injury: "There has never been a disease as complex and changeable as brain injury, which is easily overlooked, and it is desperate because of the serious injury". Since then, doctors have been exploring how to predict the prognosis of craniocerebral injury early. Today, many predictive models of craniocerebral injury have been produced. These models are mathematical models based on clinical studies of large cases, although they are controversial because of their accuracy and ethics^[1]However, some predictive models have been proven by clinical trials of bulk cases to have high discrimination power and accuracy, and can guide clinical practices within specific groups, or even be called "guidelines"^[2,3,4,5]。

Peripheral nerve injury is a common disabling disease in clinic. Among the 1~1.5 new cases/10 million trauma cases in the world every year, peripheral nerve injury accounts for 1.5% ~4.0%. There are 600,000 to 900,000 new cases of peripheral nerve injury in China every year. Compared with the central nervous system, peripheral nerves are simpler in structure and easier to regenerate. However, the degree and speed of peripheral nerve repair are still the difficulties of treatment at present. The extension of regenerative axons after peripheral nerve injury depends on a variety of neurotrophic factors, among which nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) are the most representative. For example, NGF can not only help the regeneration of damaged peripheral nerve axons, but also promote angiogenesis. However, these factors degrade rapidly in vivo, have a short half-life, are very difficult to maintain the therapeutic dose, and exhibit non-specific effects in non-neural tissues. Therefore, how to effectively use the factors in the site of nerve injury and local controlled release is still challenging^[1]。

Intracranial arteriovenous malformation (AVM) is the most common type of vascular malformation in the central nervous system, which is mainly composed of blood supply artery, malformed vascular mass and drainage vein. The arteries in the malformed vascular mass are directly drained to the vein without passing through the capillary bed. AVM is a serious threat to human health. According to statistics, the average annual bleeding rate is 0.5% and the re-bleeding rate is 29%. It is the leading cause of non-traumatic bleeding in young and middle aged people, and 5% to 25% of patients die within 1 year after bleeding, and 25% to 40% of patients have permanent neurological dysfunction^[1]。 However, no satisfactory results have been obtained in the treatment of AVM. The complication rates of surgical resection, radiotherapy and embolization are 29%, 13% and 25%, respectively^[2]Therefore, establishing an experimental model of AVM is of great value for the study of the pathogenesis and treatment strategies of AVM. In this paper, the research progress of various experimental models is reviewed.

In the broad sense, the brain-computer interface technology combines neuroscience, bioinformatics, microelectronics and other multi-disciplinary technologies, and tries to establish a kind of interface between human brain and human brain, human brain and animal brain, human brain and machine, so as to realize the communication between human brain and human brain, animal brain and machine^[1,2,3,4]Thus breaking the limitation of the biological anatomical structure of the human brain and repairing the damage of the brain or brain accessory structures such as limbs and language. This paper summarizes the latest brain-computer interface technology, focusing on the acquisition of characteristic brain signals in brain-computer interface technology and its application in clinical field.