2016年 · 第32卷第05期

Facial nerve protection has always been an important issue in the surgical treatment of vestibular schwannoma. With the advancement of microsurgical technique, the total resection of vestibular schwannoma has changed from extraordinary to ordinary, and the effective preservation of facial nerve function has gradually become the primary goal of surgical treatment. As the most important nerve structure around vestibular schwannoma, the facial nerve should be accurately assessed for its location, adjacency and morphology before surgery, whether by microsurgery or radiotherapy. Especially for large vestibular schwannoma, it is particularly important to consciously protect the facial nerve structure from damage during surgery^[1,2]。 At present, the anatomical preservation rate of facial nerve in vestibular schwannoma reported by many neurosurgical units at home and abroad has reached more than 90%, but the effective preservation rate of facial nerve function is not ideal. To change this situation, it is difficult to make new breakthroughs only by relying on microsurgery technology. Therefore, how to comprehensively use the existing medical means to further improve the facial nerve function retention rate of vestibular schwannoma is a problem that we should continue to pay attention to.

With the completion of the Human Genome Project, the intergenerational evolution of gene sequencing technology, and the progress of the Cancer Genome Atlas (TCGA) project, the current understanding of tumor-driven mutations is gradually deepening, requiring us to develop more sophisticated, effective, individual patient-specific treatment options. At the beginning of 2015, US President Barack Obama put forward the "Precision Medicine Plan", and the term precision medicine became the hottest keyword in the medical circles of all countries around the world. However, precision medicine is not a brand-new concept, but the integration and superposition of the original plan, giving a new goal. At present, there is no unified definition of its definition. In the field of tumor research, precision medicine mainly refers to the formulation of individualized treatment plans for patients based on personal genome sequencing information. Generally speaking, it is developed from "individualized diagnosis and treatment" combined with a new generation of genome sequencing technology.

Gliosarcoma is a rare malignant tumor of the central nervous system that was first proposed in 1895 by pathologist Stroebe. According to statistics, the incidence of gliosarcoma is less than 0.5% of all intracranial tumors^[1]。 Gliosarcoma consists of biphasic histology and has been confirmed to have two components: glial and sarcoma^[2]The glial component meets the World Health Organization (WHO) grade IV astrocytoma (glioblastoma multiforme) cytological criteria; The components of sarcoma are usually similar to fibrosarcoma, and sometimes their morphological manifestations are different from those of fibrosarcoma, such as osteosarcoma, chondrosarcoma, angiosarcoma or rhabdomyosarcoma. Due to the low incidence of both primary and secondary gliosarcomas, large sample prospective studies are difficult to conduct, so the current research on gliosarcomas is mainly limited to retrospective studies^[3]。 This study retrospectively analyzed the clinical data of 7 patients with cerebral gliosarcoma admitted to the Cancer Center of Beijing Millennium Monument Hospital affiliated to Capital Medical University from January 2010 to September 2015, which are now reported below and analyzed in combination with the literature.

At present, China has entered an aging society, and the number of elderly patients with cerebral hemorrhage caused by hypertension has increased significantly. Due to the particularity of physiology and anatomy of this type of patients, as well as whether they take anticoagulants for a long time, and whether they are combined with other underlying diseases, their treatment methods vary from person to person. From January 2012 to June 2015, 186 patients with hypertensive intracerebral hemorrhage were treated in the Department of Neurosurgery of Beijing Yanhua Hospital, including 96 patients (44.6%) over 65 years old. The different treatment methods are reported below.

Female, 60 years old. He was admitted to hospital in November 2012 due to "headache for half a month and right limb weakness for 1 week". Physical examination: Conscious, right limb muscle strength grade IV, left limb muscle strength normal. There was no history of seizures. MRI of the skull revealed left occipitoparietal lobe lesions, showing spot nodular enhancement of different sizes, and obvious large edema around it (Figure 1)。 Proposed diagnosis of left occipital space-occupying lesion: astrocytoma or granulomatous inflammatory reaction? Microresection of the left occipital parietal lesion was performed. During the operation, the lesions were yellow granular, slightly hard in texture, with average blood supply and unclear boundaries with surrounding tissues. Postoperative pathology: Chronic inflammatory granuloma, suggesting the possibility of parasitic infection (Figure 2)。 Considering that the patient's hometown is an endemic area of schistosomiasis and has a history of exposure to infested water, the gold serological test and NP30 test of schistosomiasis were positive. 2 courses of treatment with oral praziquantel. After 3 months, CT scan of the head showed that the lesion disappeared and the edema clearly resolved. Final diagnosis: left occipital brain tumor type schistosomiasis. After 3 years of follow-up, the patient was generally in good condition.

Glioma is the most common intracranial tumor. Gliomas classified as grade III and IV by WHO are usually collectively referred to as high-grade gliomas. Grade III glioma is anaplastic glioma, which can be further divided into anaplastic astrocytoma, anaplastic oligodendroglioma and a mixture of the two; Grade IV gliomas were mainly glioblastoma (GBM)^[1]。 At present, the main treatment for patients with high-grade glioma is a combination of surgery, radiotherapy and chemoradiotherapy, but most patients still experience tumor progression or recurrence within a short time after the first treatment. The prognosis of patients with recurrent high-grade glioma is extremely poor. In the case of recurrent GBM, the average survival time of patients is 1 to 4.5 months^[2]。 In recent years, with the rapid development and cross-penetration of oncology, immunology and molecular biology, the research of tumor immunotherapy has made great progress, which brings new hope for the treatment of malignant tumor patients. Among them, immunotherapy has achieved exciting results in the treatment of recurrent high-grade glioma with its unique advantages^[3]。 This article reviews the progress in immunotherapy of recurrent high-grade glioma.

At present, surgical resection is still the first choice for the treatment of glioma, and its purpose is to remove the tumor lesion to the greatest extent, so as to reduce the clinical symptoms of patients and improve the quality of life of patients. At the same time, through surgery to obtain a clear pathological tissue diagnosis, for the next step of radiotherapy and chemotherapy to provide treatment basis. However, traditional craniotomy generally only performs preoperative localization according to the patient's clinical symptoms, signs and imaging examinations. During the operation, the tumor location is judged by anatomical landmarks, approximate location of the lesion, indirect signs of the lesion area, surgical field structure and doctor's experience, and exposed and removed as much as possible. For superficial lesions, it is relatively easy to locate and expose them, while for lesions with smaller volume, deeper location or unclear boundaries, especially gliomas involving functional areas, it is difficult to explore and it is impossible to accurately locate the overall contour of the lesion. Therefore, how to remove the lesions in the greatest range and effectively protect brain function has become an urgent problem to be solved in neurosurgery. At present, with the continuous research and development of emerging auxiliary technologies and wide clinical application, effective total resection of glioma has become possible. In this paper, the application of these new assistive technologies is reviewed.

With the development of medical technology and treatment methods, the survival probability of patients with severe craniocerebral injury has also increased. The prognosis of the state of consciousness plays an important role in the daily care of patients and the evaluation of the effectiveness of various treatments. The prognosis of patients with consciousness disorders is divided into four distinct states: death, vegetative state/unwakefulness syndrome (VS/UWS), minimally conscious state (MCS), and exit minimally conscious state (eMCS). These four different prognostic states can translate into each other, and the treatment options and home care options adopted for these four different prognosis are very different. This article summarizes the mortality, recovery rate and recovery degree of patients with consciousness disorders from the perspective of clinical manifestations.

The incidence rate of intracranial aneurysms is about 5% ~10%, and subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms causes about 60% of disability and mortality^[1,2]。 1937, Dandy^[3]The first surgical clipping of an intracranial aneurysm was performed, after which intracranial aneurysm clipping became the main treatment. In the 1990s, the emergence of electrolytic detachable coils ushered in a new era of intracranial aneurysm treatment^[4]。 Because coil embolization has a higher survival rate and fewer complications than surgical clipping, and with the advent of new technologies and materials such as balloon and stent-assisted embolization technology and 3D biogel-coated coils, it has gradually become the preferred treatment for intracranial aneurysms^[5]。 However, large, huge, wide-necked or fusiform aneurysms still pose great challenges for surgeons. For those giant aneurysms that are difficult to surgically clip, occlusion of the tumor-bearing artery is an earlier endovascular treatment technique, and its effect mostly depends on the patient's tolerance to the occlusion of the tumor-bearing artery. However, delayed cerebral ischemia complications will still occur in 4% to 15% of patients who pass the balloon occlusion test^[6]。 The stent-assisted coil embolization technique remains poor in the treatment of large intracranial aneurysms, and although it can be further improved with overlapping intracranial stents, the effect remains uncertain.

Melanocytic tumors of the central nervous system (CNS) have a low incidence and are classified into primary and metastatic tumors. The clinical symptoms of the disease are not specific, and the tumor is easily misdiagnosed due to the difference of melanin content and combined hemorrhage, its imaging manifestations are diverse. The overall malignant degree of tumor is high, the recurrence is easy after operation, the insensitivity of radiotherapy and chemotherapy, and the treatment effect is poor, which has always been a thorny problem in the field of neurosurgery^[1,2]。 This article reviews the general characteristics, clinical manifestations, pathological and imaging features of CNS melanocytic tumors, especially the latest advances in treatment, in order to improve the understanding of this disease.

Professor Wang Yutian, member of the Standing Committee of the National Committee of the Chinese People's Political Consultative Conference, vice chairman of Hainan Provincial Committee of the Chinese People's Political Consultative Conference, chairman of Hainan Provincial Committee of Jiusan Society, member of World Chinese Neurosurgery Association, editorial board of Chinese Journal of Neurosurgery, vice chairman of Beijing Wang Zhongcheng Medical Foundation, chairman of Neurosurgery Professional Committee of Hainan Medical Association and former president of Hainan People's Hospital, died at 16: 36 on April 17, 2016 at the age of 60 due to ineffective treatment.