2016年 · 第32卷第04期

microvascular decompression (MVD) is the first surgical treatment method for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GN) and other cranial nerve diseases. It is considered as one of the most important breakthrough innovative technologies in the history of modern neurological diseases treatment. With the further development of microscopic neurosurgery and the in-depth research on the pathogenesis of cranial nerve diseases, MVD has gradually been used to treat disabling vertigo, refractory tinnitus, essential hypertension and other cranial nerve diseases, and its application is increasingly widespread.

Intracranial arachnoid cyst is a very common benign lesion in children, and its incidence rate accounts for about 1% of intracranial lesions in children, of which 90% are located in the supratentorial and 60% in the middle cranial fossa (also known as lateral fissure arachnoid cyst)^[1,2]。 Because its exact pathogenesis and natural history are not completely clear, there are no guidelines for the treatment of arachnoid cysts. The vast majority of arachnoid cysts are asymptomatic and discovered accidentally, while a few cysts can enlarge progressively, manifesting as headache, cyst rupture and bleeding, subdural effusion, epilepsy, etc. For patients with symptomatic arachnoid cysts, it is recognized that surgical treatment should be given; For asymptomatic patients, whether to give preventive surgery is currently controversial.

There are many types of congenital spina bifida, and there are various subtypes of the same type. Spina bifida depends on the degree of disease, generally, those with spinal canal contents bulge are called dominant or cystic spina bifida, otherwise they are called occult spina bifida^[1,2,3,4]。

After nearly 20 years of clinical practice in China, large bone flap craniotomy has been widely accepted and applied today, from the initial opposition and controversy in academic circles, which fully proves the important position of large bone flap craniotomy (decompression) in the treatment of acute severe craniocerebral trauma. In a recent review of the treatment of traumatic brain injury published in the New England Journal of Medicine, large bone flap surgery was also suggested as the last option for other conservative treatments^[1]。 Although there are still some reports of ineffective large bone flap craniotomy, one of the most influential negative results is Cooper et al.^[2]A multicenter study published in 2011. However, this study does not include patients with mydriasis and fixation, which obviously does not meet the surgical indications for large bone flap craniotomy in China. On the contrary, clinical practice has proved that the application and popularization of this technology has effectively treated thousands of patients with intractable intracranial hypertension who have dilated and fixed pupils after injury every year^{[3,4,5,6,7,8,9,10]}。 Although both theoretical and clinical studies have proved the effectiveness of this operation, due to the regional differences in medical level in China, especially the irregular operation techniques of doctors in primary hospitals, which leads to the deviation of treatment effect, which is also one of the important reasons why some reports of this operation are ineffective. Combined with years of clinical practice and reports at home and abroad, the author introduced the methods of traumatic large bone flap craniotomy^[7,9]。 In 2013, he published the surgical video CD of "bifrontal large bone flap decompression craniotomy" and "one-sided frontotemporal and parietal large bone flap craniotomy"^[11,12]。 After several years of communication, promotion and improvement by the Chinese Medical Physicians Association, this technology has become more and more mature. However, it is still necessary to strengthen the standardization of surgical indications and techniques to improve the overall treatment level of neurosurgeons and traumatologists across the country.

Cranial dermoid cyst is a cyst formed by epidermal cells separated along the embryonic closure line. It shows subcutaneous nodules at birth, which increase with age. It mostly occurs at the midline site, and occasionally the cyst can be seen to expand into the cranium in a dumbbell shape^[1,2,3]。 Cranial dermoid cyst in children is relatively rare in clinic, and it is common in children^[4]Clinical diagnosis and surgical treatment are relatively difficult. This article retrospectively analyzed five children with skull dermoid cyst who were admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from January 2011 to June 2014 and were confirmed by postoperative pathology. Now, their clinical characteristics and treatment results are summarized and analyzed as follows.

The incidence of intracranial aneurysms is about 2% ~5%^[1]The mortality rate after aneurysm rupture and hemorrhage is about 50%^[2]。 Therefore, aneurysms at risk of rupture should be treated aggressively. However, intervention for unruptured aneurysms is also risky. The fatality rate and disability rate after interventional treatment for unruptured aneurysms are about 1.5% ~2.3% and about 10% ~20%^[3]。 The annual rupture rate of unruptured aneurysms ranged from 0.8% to 2.0%^[4,5]It suggests that most unruptured aneurysms may not rupture for life. In recent years, the analysis of the risk factors of rupture of unruptured aneurysms has become a hot research topic at home and abroad. Therefore, we retrospectively analyzed the clinical data of aneurysm patients who attended the Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University from April 2013 to June 2014, and explored the risk factors of aneurysm rupture.

Female, 63 years old. He was admitted to the Department of Neurosurgery, General Hospital of Tianjin Medical University on July 7, 2014 for "sudden headache, dizziness and double vision shadows for 2 weeks". He underwent CT angiography (CTA) of the head, and found a huge aneurysm in the clinoid segment of the right internal carotid artery, with the widest diameter of about 30 mm (FIG. 1A)。 First, whole brain angiography was performed under local anesthesia in a Hybrid operating room. Preoperative digital subtraction angiography (DSA) showed a giant aneurysm in the clinoid segment of the right internal carotid artery (FIG. 1B)； The balloon occlusion test (BOT) of the ipsilateral internal carotid artery was also performed. After general anesthesia, routine craniotomy was performed to expose the initial part of the ipsilateral extracranial to intracranial vascular (EC-IC), and the great saphenous vein was selected as the graft vessel. The anastomosis was performed with the external carotid artery and the inferior trunk of the M2 segment of the middle cerebral artery, respectively, and then the aneurysm was isolated. Intraoperative electrophysiological monitoring showed no abnormalities. Another intraoperative DSA examination showed that the bridging vessel was patent, the distal blood supply was sufficient, and the development was good. No aneurysm development was observed (Figure 1C)； The head CTA was re-examined 1 week after surgery and showed that the graft vessels were patent (Figure 1D)。 The patient recovered well after operation and was followed up for 12 months. The carotid artery pulsed well when touched. The B-ultrasound examination of the carotid artery showed that the bypass vessel had smooth blood flow, with an internal diameter of about 5.0 mm and a flow velocity of 0.57m/s (Figure 1E，Figure 1F)。 The patient is currently able to take care of himself, has no neurological deficit, and has a modified Rankin scale score of 0.

Chordoma is a relatively rare low-grade malignant tumor, accounting for 1% to 4% of malignant bone tumors, and its incidence in the population is less than one in a million. The onset age of chordoma patients is about 50 to 60 years old, and the incidence rate is higher in men than in women. The surveillance epidemiology and end results program (SEER) showed that the median overall survival of chordoma patients was 6.29 years^[1]。 The onset sites of primary chordoma include sacrococcygeal region (50%), skull base (35%) and other axial bones (15%)^[2], mainly divided into 3 pathological types, namely: classical type, cartilage type and dedifferentiated type. The main pathological characteristics of chordoma are that a large number of vacuolar structures can be observed in tumor cells under microscope, and the positive expression of S-100 protein, cytokeratin, epithelial membrane antigen and transcription factor T gene (Brachyury) can be detected by immunohistochemical staining^[3,4]。

Moyamoya disease is a cerebrovascular disease characterized by progressive stenosis or occlusion of bilateral internal carotid arteries and initial segments of anterior and middle cerebral arteries, accompanied by abnormal vascular network formation at the base of the skull^[1,2]。 Patients with moyamoya disease may be complicated with aneurysms, and aneurysms tend to form at weak sites of blood vessels such as abnormally dilated collateral pathways^[3]。 This article summarizes the literature at home and abroad, and summarizes the diagnosis and treatment of moyamoya disease with peripheral arterial aneurysm.

persistent vegetative state (PVS) is a state after severe brain damage, that is, the functions of the brain stem and diencephalon are relatively preserved, while the function of the cerebral cortex is lost. Patients exhibit vegetative survival state with only the minimum response-sleep/wake cycle, can open their eyes but are unconscious, and cannot communicate with the surrounding environment or people. 1972, by Jennett and Plum;^[1]The concept of PVS was proposed for the first time. With the progress of clinical research and the development of ethics, in recent years, some European scholars have suggested that unresponsive wakefulness syndrome (UWS) be used to describe this group of people. Because UWS makes patients' families more psychologically acceptable, more in line with ethical requirements, and can make clinical workers hold a more positive attitude and objectively evaluate patients' condition, which may have more positive significance than PVS^[2]。

mitogen-activated protein kinases (MAPK) chain is one of the important pathways in eukaryotic signal transmission network. It is widely distributed in the cytoplasm. It is an important signal transduction system that can transmit extracellular stimulation signals to the nucleus, thus causing cell biological response, and plays a key role in gene expression regulation and cytoplasmic function activities. The MAPK chain includes four basic signal transduction pathways: (1) extracellular regulated protein kinases 1/2 (ERK1/2) pathway, (2) p38 MAPK pathway, (3) c-Jun N-terminal kinases (JNK) (4) big mitogen-activated protein kinase 1 (BMK1 or ERK5) pathway^[1]。 Craniocerebral trauma is caused by mechanical damage caused by external force on the brain, resulting in local brain tissue damage, nerve cell death, and the release of various harmful chemicals, such as stress hormones, inflammatory mediators, free radicals, cytokines, etc., which then initiates a series of complex biological effects of nerve cells, resulting in cerebral ischemia, hypoxia, cerebral edema, neurological deficit and other secondary brain injuries. In recent years, many studies have shown that MAPK pathway is activated after craniocerebral trauma, and is involved in regulating various cellular stress responses after craniocerebral trauma, and is the main signaling pathway of cellular stress and injury response^[2,3]。 This paper briefly summarizes the role of MAPK pathway in the occurrence and development of craniocerebral trauma.

The surgical treatment of cerebrovascular disease has been attracting much attention. The first superficial temporal-middle cerebral artery (STA-MCA) vascular anastomosis was successfully performed by Yarsargil and Donaghy in 1967^[1]。 In the following decades, with the progress of treatment level, the role of cerebrovascular anastomosis in cerebrovascular diseases has attracted more and more attention, but its application value is still controversial. This article summarizes the related cerebrovascular diseases treated by vascular anastomosis, the improvement of anastomosis techniques and materials as follows.