2016年 · 第32卷第10期

Functional neurosurgery is a surgical method to correct the abnormalities of nervous system function, mainly aiming at specific nerve roots, nerve circuits, neuron groups (brain nuclei) and brain networks, aiming at changing pathophysiological processes and reconstructing the normal function of nerve tissue. Functional neurosurgery is an important part of neurosurgery, and it is one of the most rapidly growing, dynamic and promising branches. According to the literature reports, functional neurosurgery and spinal neurosurgery are on the rise compared with all subspecialties of neurosurgery, and the popularity and vigorous development of functional neurosurgery in China in recent years can also be used as evidence^[1]。

microvascular decompression (MVD) is the first surgical treatment for primary trigeminal neuralgia, idiopathic hemifacial spasm, primary glossopharyngeal neuralgia and other functional diseases. In MVD, after the responsible blood vessel that compresses the root entry/exit zoon (REZ) of the corresponding cranial nerve root is separated and pushed apart, an implant is placed between the brainstem and the responsible blood vessel to pad the blood vessel to prevent the vascular reduction from re-compressing the REZ. Over the years, many materials have been used as decompression implants in MVD, so it is necessary to standardize the selection and correct use of their materials.

Sturge-Weber syndrome (SWS), also known as cerebrofacial hemangiomatosis or cerebral trigeminal hemangiomatosis, is a rare and sporadic congenital neurocutaneous syndrome^[1]Caused by GNAQ gene mutation, non-hereditary, with an incidence of 0.02‰ ~0.05‰, manifesting as vascular malformations involving the brain, skin and eyes. Vascular malformations in the brain often cause intractable epilepsy, and different individualized treatment programs are needed according to different conditions. A total of 3 children with epilepsy with Sturge-Weber syndrome were treated in the Department of Neurosurgery, Yuquan Hospital, Tsinghua University from January 2010 to December 2015. The efficacy was satisfactory, and the results are reported as follows.

The trochlear nerve originates outside the inferior colliculus, is the only cranial nerve connected to the dorsal side of the brainstem, and has the longest path in the cranium. In the lateral area of the tentorial hiatus, the trochlear nerve walks below the tentorial margin and within the tentorial, which is called the tentorial segment trochlear nerve. During surgery in this area, the tentorial trochlear nerve creates an obstacle to exposure and manipulation of the subtentorial region, and is also highly susceptible to surgical injury. According to foreign reports, the injury rate of trochlear nerve is 13% ~28% after operation of meningioma at the free edge of the tentorial hole^[1,2]。 The traditional infratemporal transtentorial approach is to incise the tentorium parallel to the petrous crest located 1 cm behind the point where the trochlear nerve enters the tentorium, but the remaining triangular tentorium portion near the petrous apex will still occlude the exposure of the infratentorial structure. In this paper, the anatomical study of five cadaveric specimens was carried out. By freeing the trochlear nerve in the tentorial segment, the method of tentorial incision was improved, and the scope of tentorial incision was enlarged. Furthermore, the operating space of the infratentorial region, especially the superior and middle segments of the basilar artery and the Meckel cavity of the trigeminal nerve through the infratemporal-tentorial approach was enlarged. At present, there are few relevant literature reports at home and abroad, and the results are reported as follows.

In recent years, the incidence of craniocerebral trauma complicated by central cerebral hernia in the population has shown an increasing trend year by year. Because the patients with craniocerebral trauma complicated by central cerebral hernia are relatively mild in the early stage of the disease, they often do not receive corresponding attention from doctors and delay the treatment, resulting in the gradual aggravation of the disease, thus affecting the prognosis of patients and increasing the fatality and disability rate. In order to explore the diagnosis and treatment of craniocerebral trauma complicated with central cerebral hernia, this article retrospectively analyzed the clinical data of 15 patients with craniocerebral trauma complicated with central cerebral hernia admitted to the Department of Neurosurgery, Wudu District First People's Hospital, Longnan City, Gansu Province from December 2008 to June 2015, and now reported as follows.

Lateral ventricular anterior horn puncture is one of the most basic operation techniques in neurosurgery. In clinical work, there are often defects such as unsuccessful puncture, unsatisfactory position of ventricular end of drainage tube, which affects drainage effect, and brain injury and hemorrhage caused by multiple punctures, which seriously affects the prognosis of patients. Neurosurgery Department of Tianshui First People's Hospital Based on Traditional Location Method^[1]The gradually established virtual plane intersection positioning method can improve the puncture success rate and the satisfaction rate of the ventricular end position of the drainage tube, which is reported as follows.

Internal carotid artery blood blister-like aneurysm (BBA) is an aneurysm that originates from the anterior or anterior inner wall of the proximal superior clinoid segment of the internal carotid artery (ICA) and is not related to the ICA branch. It is named because the tumor wall is mostly wide, thin, visible blood flow, and bright red in appearance, which is "vesicle-like"^[1]。 BBA is rare, accounting for about 0.3% to 1.0% of all intracranial aneurysms and 0.9% to 6.5% of intracranial ICA aneurysms^[2]。 Subarachnoid hemorrhage (SAH) is the clinical manifestation of BBA. Because the tumor wall of BBA is thin and the rebleeding rate is high, active treatment should be taken after definite diagnosis^[3,4]。 Currently, despite the wide variety of treatments for BBA, there is still no optimal treatment^[5]。 The Department of Neurosurgery of the First Affiliated Hospital of Wenzhou Medical University used LVIS stent to treat 2 cases of internal carotid artery BBA, and achieved good results, which are reported below.

In 1898 Ferguson first diverted cerebrospinal fluid from the lumbar subarachnoid space to the abdominal cavity^[1]lumboperitoneal shunt (LPS), with the research and development of shunt materials and the progress of surgical technology, especially the invention and application of LPS special shunt valve, LPS has gradually been accepted by people. Compared with ventricular-peritoneal shunt, LPS has the advantages of no ventricle puncture, short subcutaneous tunnel, less surgical trauma, etc., and has become one of the main surgical methods for treating communicating hydrocephalus in recent years^[2,3]。 Hydrocephalus shunt peritoneal catheterization technique can be divided into traditional abdominal wall incision catheterization and puncture catheterization. Abdominal wall incision usually requires the cooperation of two staff members, and the incision is generally more than 3 cm. If the patient is obese, the incision is longer, and the subcutaneous fat and muscle are separated during the operation, and the operation time is longer. When performing LPS, the patient usually takes the lateral position, which also increases the difficulty of abdominal wall incision to a certain extent^[4]。 Therefore, the author adopted pneumoperitoneum puncture and catheterization technique in LPS, and its efficacy was satisfactory, which is presented as follows.

PatientFemale, 72 years old, right-handed, developed slight tremor in her left upper limb more than 10 years ago. Five years ago, her symptoms involved her right upper limb and head, and she developed severe tremor in her vocalization, unable to finish eating, drinking, dressing and writing on her own. Poor drug efficacy, family history of essential tremor. The Fahn-Tolosa-Marin tremor rating scale (FTM-TRS) was 78 points. A skull CT scan was performed on the day of surgery and the CT and preoperative MRI images were fused on Framelink software. According to the anterior and posterior commissures, the target of the ventromedial nucleus of the thalamus (Vim nucleus) was calculated on the T1 image. The puncture diameter took the middle frontal gyrus cortex of the coronal suture as the entry point. After reaching the target of the Vim nucleus, it went deep about 5 mm to the maximum plane of the red nucleus, that is, the posterior subthalamic area (PSA) located between the subthalamic nucleus and the red nucleus. The patient underwent deep brain stimulation (DBS) on the left side first, and the microelectrode recorded to the target and then went 5 mm deep. There was no obvious discharge under the target (consistent with the characteristics of PSA). Intraoperative micro-damage effect was obvious, and the tremor of the patient's right hand was significantly reduced. Medtronic 3387 electrode was replaced, and the efficacy was tested. Right DBS was performed in the same way. There was no pneumocranium on CT reexamination at 6 days after operation, which was fused with preoperative MRI (Figure 1)。 DBS was turned on 1 month postoperatively, and the last parameters tested were: right electrode: 2-C + (located in the Vim core), 60 μ s, 160 Hz, 2.0 V; Left electrode: 9-C + (at PSA), 60 μ s, 160 Hz, 2.0 V. The left hand tremor disappeared and the right hand, head and voice tremor were alleviated with an FTM-TRS score of 20 and no adverse reactions. Tremor was significantly alleviated with the application of the bilateral lowermost contacts (located in the PSA), but did not stop. Voltages above 2.0 V have not been attempted and synergistimulation has not been attempted.

The pituitary stalk is an important structure connecting the hypothalamus and the pituitary gland^[1]。 A variety of diseases can lead to thickening of the pituitary stem, but it is difficult to clarify the cause due to the non-specific clinical manifestations and the limitation of diagnosis and treatment. This paper summarizes the etiology of thickening of pituitary stem and its progress in diagnosis and treatment.

cavernous malformations (CMs) are cavernous malformations composed of many abnormally thin-walled blood vessels, which can occur in any part of the central nervous system, and their main clinical features are recurrent bleeding and epilepsy^[1]。 Among them, CMs located in the brainstem is difficult to surgically remove because of the deep location of the lesion and adjacent to many important structures, which is a difficult problem in neurosurgery. At present, scholars at home and abroad widely agree that most brainstem CMs can be resected by microsurgery, and the therapeutic effect is positive^[2,3]In this paper, the current situation of surgical treatment of brainstem CMs is reviewed in combination with the reports of relevant literature at home and abroad in recent years.

Intracranial aneurysm is a tumor-like abnormal protrusion of intracranial artery wall caused by various reasons, and its incidence is about 5% ~10%^[1]In which rupture hemorrhage accounts for 70% of subarachnoid hemorrhage, causing a higher residual mortality rate^[2]。 Among them, the rupture of giant aneurysm caused subarachnoid hemorrhage reached 25% ~70%, and the rebleeding rate within one week reached 15%. In recent years, the emergence of blood flow guidance devices represented by PED (pipeline embolization device) has changed the concept of endovascular treatment of intracranial aneurysms, and shifted the conventional packing of tumor sac to reconstruction of blood vessel wall. The research progress of blood flow guidance device in the treatment of intracranial aneurysm is summarized as follows.

Subarachnoid hemorrhage (SAH) caused by ruptured aneurysm has a high mortality and disability rate, and most patients (70%) who survive after SAH develop cerebral artery contraction, i.e. cerebral vasospasm. Most scholars believe that arterial stenosis caused by cerebral vasospasm can lead to cerebral ischemia or even cerebral infarction, so they are committed to alleviating cerebral vasospasm to improve the prognosis of SAH patients^[1]。 However, the efficacy of SAH patients after systemic treatment is not ideal. During treatment, Ca^2＋The blocker nimodipine is used to improve cerebral vasospasm. However, studies have found that although nimodipine is effective for SAH, its effect does not originate from the treatment of cerebral vasospasm^[2]。 In addition, patients with cerebral vasospasm after SAH do not necessarily develop delayed ischemic brain injury, while patients with delayed ischemic brain injury after SAH do not necessarily have cerebral vasospasm, which indicates that cerebral vasospasm after SAH may not be the main cause of poor prognosis in SAH patients^[3]。 A growing number of studies have shown that early brain injury plays an important role in the poor prognosis of SAH^[4]。 Despite the increasing understanding of the mechanism of action of early brain injury in SAH, SAH remains a difficult problem in today's treatment. Perivascular cells are an important component of the blood-brain barrier, and are the only cells with contractile and diastolic functions. They play an important role in the regulation of cerebral microcirculation in pathophysiological processes after SAH. In the past, pericytes were often neglected due to their unclear function and lack of specific markers. The continuous discovery of pericyte marker molecules and the rapid development of experimental technology have greatly promoted the research of pericyte. Mounting evidence shows that cerebral vascular pericytes are associated with a variety of neurological disorders^[5]。 In this paper, the research progress of the role of vascular pericytes in SAH is reviewed.

With the development of social and economic activities, the incidence of spinal cord injury (SCI) is increasing year by year. While SCI brings serious physical and psychological harm to patients, it also causes a huge social burden. Therefore, the research on the correlation of SCI with prevention, treatment and rehabilitation as the main body has become a major topic in the medical field today. In the acute stage of SCI, in order to protect the spinal cord that has not been completely injured, it is necessary to take reasonable and effective neuroprotective measures early after injury, so as to promote the recovery of spinal nerve function to a certain extent. This paper briefly reviews the research progress of SCI drugs in neuroprotection and therapy.