2016年 · 第32卷第06期

Since 2001, The results of The international multicenter randomized clinical trial (RCT) on craniocerebral trauma have been published in The New England Journal of Medicine and The Lancet. These studies included intracranial pressure (ICP) monitoring in patients with craniocerebral trauma^[1]Decompressive craniectomy^[2]Cryogenic technology^[3,4]Ultra-high-dose glucocorticoids^[5]Calcium antagonist^[6]Progesterone,^[7,8]hemostatic agent^[9,10]etc., which has attracted the attention of neurosurgeons all over the world and greatly affected the global clinical treatment methods of craniocerebral trauma. At present, there is no obvious controversy about the RCT results of drug treatment for craniocerebral trauma. However, how should international evidence-based medical evidence such as ICP monitoring technology, decompressive craniectomy and hypothermia technology be interpreted scientifically, objectively and correctly? This article focuses on the interpretation of these evidence-based medical evidence, and uses it as a basis to standardize the clinical treatment strategies of craniocerebral trauma in China.

With the advancement of medical technology, the development of intraoperative imaging and navigation technology, the continuous update of visual magnification lighting equipment and precision surgical instruments, and the further understanding of anatomy and physiology, minimally invasive spinal surgery technology has developed rapidly, and surgeons have been able to complete operations that could only be completed by open surgery in the past through one or more tiny incisions. Minimally invasive spinal surgery can achieve minimally invasive nerve decompression, spinal stabilization and fusion, and correction of spinal deformities.

Consciousness disorders mainly include vegetative states and microconscious states. In recent years, it has been found that spinal cord stimulation (SCS) can promote awakening in patients with consciousness disorders^[1,2]。 However, the current clinical stimulation parameters, especially the frequency selection, are very different, and the curative effects are different, and they are all based on clinical experience and have no objective basis. Kanno et al.^[3]A summary of 214 patients treated with SCS in a persistent vegetative state with a stimulation frequency of 70 Hz, of which 54% achieved a good clinical improvement. Some studies have also shown that the stimulation frequency of 5 Hz can improve cerebral blood flow in patients with micro-consciousness, cause upper limb muscles to twitch, and contribute to their functional neurological rehabilitation^[4]。 Because the mechanism of action of SCS in the treatment of consciousness disorders is not clear at present, it is impossible to determine the effect of the change of stimulation frequency on brain function clinically.

solitary plasmacytoma is a malignant tumor caused by monoclonal proliferation of plasma cells. It is classified as a subtype of plasma cell tumor in WHO classification, including solitary extramedullary plasmacytoma (SEP) and solitary plasmacytoma of bone (SPB)^[1]。 Solitary plasmacytoma occurring in the spinal canal is extremely rare. The disease has an acute onset and rapid development, with progressive aggravation of symptoms and even paraplegia. Intraspinal solitary plasmacytoma has rarely been reported. This study retrospectively analyzed the clinical data of 5 patients with solitary plasmacytoma in the intraspinal canal admitted to the Department of Neurosurgery of the Third Hospital of Hebei Medical University from June 2002 to December 2014, which are reported below.

Dumbbell-shaped spinal canal tumor is difficult to resect because it involves multiple sites in the spinal canal, intervertebral foramen and outside the spinal canal at the same time^[1,2]。 Eden^[1]According to the characteristics of tumor growth, dumbbell-shaped spinal canal tumors are divided into four types. Among them, Eden 4 dumbbell-shaped spinal canal tumors are mainly originated from the intervertebral foramen and developed outside the spinal canal. The main body of the tumor is located outside the spinal canal but there is no tumor in the spinal canal. retroperitoneal dumbbell lumbar spinal schwannomas (RDLSSs) belong to Eden type 4, and their growth pattern is that the tumor protrudes to the retroperitoneal space through one lumbar intervertebral foramen. It is precisely because the main body of RDLSSs tumor is located in the retroperitoneal space that the traditional posterior median (or paramedian) translaminar approach is not only difficult to resect the tumor, but also traumatic to surgery. In recent years, with the development of endoscopic microinvasive technology, endoscopic resection of spinal canal tumors has been gradually carried out^[3]。 From June 2013 to December 2014, 3 cases of RDLSSs tumors were resected by laparoscopic trans-retroperitoneal anterior approach in the Department of Neurosurgery, Nantong University Affiliated Hospital, and satisfactory results were achieved.

Traumatic posterior cranial fossa epidural hematoma in children is relatively rare, accounting for 0.1% ~0.3% of craniocerebral trauma and 1.2% ~12.9% of epidural hematoma^[1,2,3]。 The clinical signs and symptoms of traumatic posterior fossa epidural hematoma are associated with the compression of important structures of the posterior fossa, but their manifestations are atypical in the pediatric population, easily missed, and the disease progresses rapidly and can be life-threatening^[3]。 This study retrospectively analyzed the clinical data of 47 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery, Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to August 2015, and summarized their clinical characteristics and treatment options.

Chordoid glioma is a rare intracranial tumor with WHO grade II, most of which originate in the third ventricle. This designation was first proposed by Brat et al. in 1998^[1,2]。 This type of tumor is more common in women, with a male-to-female ratio of 1: 2, and is more common in middle-aged people aged 30-60^[3]。 The name of the tumor is derived from its own specific histological manifestations, namely the cord-like arrangement of tumor epithelioid cells under the light microscope and the positive response of glial fibrillary acidic protein (GFAP) in immunohistochemistry^[4,5]。 There are few literature reports about this disease at home and abroad. So far, about 81 cases have been reported internationally, and only a few cases have been reported in China^[6,7]。 This article retrospectively analyzed 4 patients with chordoid glioma admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from January 2014 to December 2015, and analyzed and summarized their clinical data, imaging, pathological characteristics, treatment methods and prognosis factors.

The surgical treatment of many neurosurgical diseases requires craniotomy through the frontal base approach. In order to ensure the exposure of the surgical field, the frontal sinus is inevitably opened during the operation. For some patients with developed frontal sinuses, it is even necessary to open the frontal sinus wall in a large area. In order to ensure the integrity of the sinus wall and avoid postoperative cerebrospinal fluid leakage, bone wax is routinely used to reconstruct the frontal sinus wall. Most patients did not have any discomfort after operation, but a few patients may develop frontal sinus and nearby scalp infection and sinus tract formation after operation. From July 2008 to July 2014, 14 patients who underwent frontal craniotomy and intraoperative frontal sinus opening and bone wax closure, and postoperative frontal sinus and scalp infection and sinus tract formation were treated in the Department of Neurosurgery of Henan Provincial People's Hospital. The management experience is introduced as follows.

At present, it is believed that chordoma originates from the residual chorda tissue of the embryo, and mostly occurs in the axial bone^[1]。 35% of chordomas were located at the junction of the sphenoid and occipital bones, 55% were located in the sacrococcygeal region, and the remaining 10% were located elsewhere in the spine^[2]。 For skull base chordoma, surgery combined with radiotherapy is generally recommended, but the efficacy is not satisfactory, and the 5-year progression-free survival rate is only 50.8%^[3]with a median survival of 6.29 years^[4]。

Some severe patients, such as spontaneous cerebral hemorrhage, severe craniocerebral injury, septic shock patients, etc., have lower than normal levels of glucocorticoids in the early stage of the disease, so some scholars have put forward the concept of critical illness-related corticosteroid insufficiency (CIRCI)^[1]。 CIRCI is defined as insufficient activity of cellular glucocorticoids, which is difficult to adapt to the needs of severe diseases. It is manifested by insufficient downregulation of pro-inflammatory transcription factors mediated by glucocorticoids and their receptors, which leads to a continuous increase of pro-inflammatory mediators. Therefore, the research of CIRCI is helpful to judge the patient's condition and prognosis, and further guide clinical treatment.

normal pressure hydrocephalus (NPH) was first reported as the first curable form of dementia. It wasn't until 1963 that Hakim and Adams first named the disease NPH. In the first decades, the treatment of cerebrospinal fluid shunt was not favorable due to backward shunt technology, low clinical success rate and frequent complications. In recent years, with the improvement of diagnosis and treatment of NPH, the clinical success rate of cerebrospinal fluid shunt has reached 70% ~90%. The risk assessment data also showed that surgically treated NPH patients had a significantly better prognosis than non-surgically treated NPH patients. NPH patients without surgery survive only a few months or less and have a poor quality of life^[1]。 However, so far, even if a more suitable treatment for NPH is found, only 10% ~20% of NPH patients can receive targeted treatment in time. The main reason is that NPH is difficult to diagnose early and it is difficult to differentiate from other neurodegenerative diseases. In this paper, the recent progress in the diagnosis and treatment of NPH was reviewed in order to provide assistance to the clinical work related to NPH.

In recent years, the nosocomial infection problem of Acinetobacter baumannii has become increasingly prominent, and now it has become the most common iatrogenic infection pathogen together with methicillin-resistant staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Extremely poor prognosis for intracranial infections caused by multidrug-resistant Acinetobacter baumannii^[1]Thus, it has become an extremely difficult problem in the neurosurgical intensive care unit (NICU). In this paper, the general situation, drug resistance mechanism and prevention and treatment of intracranial infection caused by Acinetobacter baumannii were reviewed in order to provide reference information for clinical work.

The primary cause of compressive optic neuropathy is intracranial space-occupying lesions, and the sellar region is the most common, including pituitary adenoma, craniopharyngioma, meningioma, etc. Space-occupying lesions cause mechanical compression on optic nerve. Many patients are diagnosed in ophthalmology for the first time due to visual loss, visual field defect and optic nerve atrophy in the early stage^[1]。 At present, visual field examination is the "gold standard" for diagnosing visual path lesions, but it is a subjective examination with great variability. Early reports lack consistency, and it is difficult to accurately assess the prognosis of patients' visual function. With the widespread application of optical coherence tomography (OCT) in clinical practice, the related research on patients with compression optic neuropathy has become a hot spot. Compared with visual field examination, OCT has the advantages of rapid, non-contact, non-invasive, high resolution and good repeatability. By measuring the thickness of nerve fibers and the volume of macula, the damage of retina and optic nerve structure can be detected early, and the sensitivity is high; Can quantitatively and objectively evaluate the damage of optic nerve diseases such as compressive optic neuropathy; Moreover, OCT is helpful for the differential diagnosis of diseases, such as compression optic neuropathy and glaucomatous optic neuropathy. Due to early atypical visual field changes, differential diagnosis can be difficult or even misdiagnosed. OCT has certain advantages in differentiating these two diseases. Because OCT can be quantitatively detected, it is helpful to predict the visual function of patients after relieving compression. This article reviews and analyzes the evaluation of optic nerve injury in patients with sellar area occupying space by OCT.

solitary fibrous tumors (SFT) are rare spindle cell tumors. They were originally thought to originate from mesothelial cells in the serous cavity. Kemperer and Robin reported that SFT occurred in the visceral pleura in 1931. Later, it was discovered that it also occurred in a variety of organs and soft tissues other than the serous membrane, such as upper respiratory tract, lung, mediastinum, pericardium, nasal cavity, orbit, parotid gland, liver, kidney, testis and central nervous system^[1,2]。 With the accumulation of clinical cases and the development of pathological diagnosis techniques, the concept that SFT originates from mesenchymal cells has been widely accepted. In 1996, Carneiro et al.^[3]The first case of SFT occurring in the meninges is reported. So far, only about 200 cases of solitary fibrous tumors of the central nervous system (cSFT) have been reported, most of which are individual cases or small cases, and more than 10 cases are rarely reported^[4,5,6,7]。