2016年 · 第32卷第11期

In his speech at the National Conference on Science and Technology Innovation, the Academicians' Conference of the Two Academies of China and the Ninth National Congress of China Association for Science and Technology, * pointed out: "The study of brain connection map is the scientific frontier of cognizing brain function and then exploring the essence of consciousness. This exploration not only has important scientific significance, but also has a guiding role in the prevention and treatment of brain diseases and the development of intelligent technology". The inclusion of brain map research in the strengthening strategic direction of national scientific and technological development has encouraged neuroscience and technology workers, and at the same time, they feel deeply responsible.

intracranial arterial dissection (IAD) refers to a disease in which blood components enter the blood vessel wall through the damaged intima of the intracranial artery for various reasons, resulting in peeling and delamination between the blood vessel walls to form hematoma, or spontaneous hematoma in the intracranial artery wall, resulting in stenosis, occlusion or rupture of blood vessels^[1]。 If a tumor-like protrusion forms, it is called an intracranial dissecting aneurysm (IDA)^[1]。 The specific cause of IAD is currently unknown, and the predisposing factors found in epidemiology include hypertension, oral contraceptives, migraine, history of trauma and recent infection^[2,3]。 Genetic factors are considered to be independent risk factors for the disease^[2]。 IAD is a rare disease, and its incidence in China is unknown. Studies have shown that the incidence of IAD in Asian population is significantly higher than that in European and American population, and the incidence of IAD in posterior circulation (76% ~93%) is higher than that in anterior circulation^[4]。 Although the incidence rate is low, IAD is one of the important causes of stroke in young and middle-aged people, which can cause headache, ischemic symptoms, subarachnoid hemorrhage (SAH) and compressive symptoms^[2,3,5]。 With the continuous progress of medical imaging technology, the detection rate of this disease is increasing year by year^[6]。 However, at present, there is a lack of unified imaging diagnosis and classification standards for this disease both internationally and domestically; Some angiography techniques still lack strong evidence-based medical evidence in the diagnosis and clinical application value of this disease; Clinicians also lack a unified understanding of the imaging features of intracranial dissection lesions. These problems affect the diagnosis and treatment of IAD lesions to some extent.

The World Health Organization (WHO) first published the Histological Classification of central nervous system (CNS) Tumors in 1979. After many revisions in 1993, 2000 and 2006, the fourth edition of the WHO Classification of CNS Tumors "Blue Book" was published in 2007^[1]。 This edition of "Blue Book" mainly classifies and grades tumors according to the histological characteristics under light microscope. The histopathological and clinical diagnostic criteria provided by this edition are still recognized and used by countries all over the world. However, with the development of individualized medicine, molecular pathological diagnosis has been more and more used in clinical practice^[2,3,4]The Chinese Glioma Cooperative Group (CGCG) has incorporated molecular pathology diagnosis into the CNS tumor diagnosis and treatment guidelines and provided a diagnostic process^[5]。 In 2014, the International Society of Neuropathology (ISN) invited 28 senior neuropathologists from 10 countries to hold a meeting on CNS tumor classification and grading in Haarlem, the Netherlands. The meeting reached a consensus that the new version of CNS tumor classification should add molecular pathological diagnosis on the basis of histology, and provided specific diagnostic criteria^[6]。 On this basis, the 2016 WHO meeting updated the fourth edition of the "Blue Book" (2016 CNS WHO), which has important guiding significance for improving the diagnosis and treatment of CNS tumors^[7]。 Combined with the relevant literature recently published in China, the following is interpreted for reference.

Because of its deep location and complex adjacent structures, the choice of surgical approach is crucial to the success or failure of surgery. Typically, the surgical approaches for posterior third ventricle tumors include the subtentorial supracerebellar approach (Crause approach) and the occipital-tentorial approach (Poppen approach). From January 2012 to September 2015, the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University used the transfrontal cortex-ventricle-fornix approach to resect 5 cases of posterior tumors of the third ventricle with the main body located above the anterior tegment of the midbrain, and achieved good clinical results, which are now reported as follows.

There are 7 siblings in a family, including 5 girls and 2 boys. Three of the women had tubercle sellae meningioma (all pathologically confirmed), and the remaining four were subjected to cranial MRI at family follow-up, and no meningioma was found. Three cases of familial tubercle sellae meningioma are reported below.

collision tumor refers to two kinds of tumors with different histomorphology appearing at the same site, which is very rare in clinic. Collision tumors that occur in the central nervous system are even rarer clinically. Pituitary adenomas have been reported to coexist with many sellar lesions, with co-existing pituitary adenomas ranging from non-functional to functional, functional pituitary adenomas including growth hormone (GH), prolactin (PRL), adrenocorticotropic hormone (ACTH), and thyrotropin (TSH)^[1,2,3,4]。 Preoperative diagnosis of two different pathological types of tumors in the sella turcica region is very difficult because most tumors have preoperative clinical and imaging findings similar to those of pituitary adenomas, and the final diagnosis of sellar collision tumors depends on histopathological examination. However, the pathogenesis of sellar collision tumor has not been confirmed. The aim of this article is to report the surgical experience of a case of sellar collision tumor and to reveal the origin and pathogenesis of sellar collision tumor through a literature review.

PatientMale, 47 years old. On March 15, 2016, he was admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Zhejiang University School of Medicine with "pituitary adenoma 6 and a half years after operation, blurred vision in both eyes for 1 year and aggravated for more than half a year". The patient had undergone MRI on 29 Sep 2009 due to visual loss and was diagnosed with "pituitary adenoma" (FIG. 1A，FIG. 1B), pituitary hormones are in the normal range, considered as "non-functional pituitary adenoma", transnasal sphenoidal sinus pituitary adenoma resection was performed in our hospital. Postoperatively, it was confirmed by pathology as "pituitary adenoma", and MRI showed that the tumor was subtotal resection (Figure 1C), visual acuity returned to normal, no radiotherapy was performed. MRI showed partial tumor recurrence at 1 year postoperatively (Figure 1D)。 One year ago, blurred vision in both eyes appeared again without obvious trigger, and the symptoms progressively worsened in the past six months, without headache, dizziness, polydipsia, polyuria and other discomfort. MRI at local hospital revealed recurrence of pituitary adenoma. Previous history of neck mass removal.

neurofibromatosis (NF) is a common neurocutaneous syndrome or nevi macular hamartomatosis. The main clinical manifestations are multiple nervous system (central and peripheral) tumors, skin pigmented spots, vascular system and other organ lesions^[1,2]。 Cases of skull dysplasia combined with NF are rarely reported at home and abroad after being admitted to hospital due to trauma. One case was admitted to the Department of Neurosurgery of Qingdao Eighth People's Hospital in May 2016, which is now reported as follows.

Parkinson's disease (PD) is a neurodegenerative disease common in middle-aged and elderly people, with resting tremor, muscle stiffness, bradykinesia and postural balance disorder as the main clinical manifestations. In addition to motor symptoms, most patients often have non-motor symptoms (NMS)^[1]Including sensory disorders, sleep disorders, autonomic dysfunction, neuropsychiatric disorders, cognitive dysfunction, etc. With the progression of the disease, NMS is an important factor in aggravating the motor function impairment, reducing the quality of life and shortening the life expectancy^[2]。 Diverse motor symptoms and NMS indicate heterogeneity in PD^[3]。 According to the onset age of patients, the speed of disease course, different motor symptoms and cognitive characteristics, PD patients can be divided into different subtypes. Typing helps to understand the pathogenesis of different symptoms, predict the course and prognosis of the disease, and provide a basis for the accurate treatment of PD. This article reviews the clinical classification of PD patients and the pathophysiological, biochemical and functional imaging characteristics of different PD subtypes.

With the rapid development of society, the injury factors such as car accident and fall are increasing, and the occurrence of traumatic brain injury (TBI) is increasingly frequent. venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embilism (PE), are serious complications in patients with TBI, resulting in increased disability and mortality. Although low molecular weight heparin can effectively reduce the incidence of VTE, prophylactic anticoagulation will increase the risk of intracranial hemorrhage when patients have TBI, so there is no unified clinical prevention opinion at present. Referring to the relevant literature at home and abroad, the incidence, risk factors and drug prevention strategies of VTE in TBI patients are reviewed as follows.

As an ancient treatment method, hypothermia has been used for many years. Since 1990s, the effect of mild hypothermia on brain protection after craniocerebral injury has gradually attracted attention. However, a series of clinical studies around mild hypothermia suggest that the brain protection effect of mild hypothermia is controversial. With the in-depth research on the change of body temperature of patients in neurological intensive care unit (NICU) and the development of body temperature control technology, the concept of "induced normothermal therapy" has been put forward in recent years, that is, the brain temperature of patients with craniocerebral injury is controlled at 36.5~37 ℃, so as to avoid adverse reactions caused by low temperature and craniocerebral injury caused by high temperature. The author makes a comprehensive review of the history of hypothermia therapy, the physiology of brain thermoregulation, the mechanism of hypothermia on brain protection, the clinical application and controversy of mild hypothermia, and introduces the concept of induction of normothermia therapy.

Gliomas are the most common primary brain tumors, accounting for approximately 28% of all brain tumors^[1], accounting for about 81% of malignant brain tumors^[2]。 Malignant gliomas mainly include anaplastic astrocytoma (WHO grade III) and glioblastoma multiforme (GBM) (WHO grade IV). Among them, the median survival of anaplastic astrocytoma is less than 3 years^[3]； GBM accounts for about 16% of primary brain tumors^[4]With a median survival of 12 to 14 months^[3]。 At present, the standard treatment plan of GBM is to maximize surgical resection combined with radiotherapy and alkylating agent adjuvant chemotherapy on the basis of protecting neurological function to the greatest extent. However, that 5-year survival rate of GBM is still below 10%^[5]The overall median survival was 16 to 19 months^[6]。 Among them, chemotherapy resistance of glioma cells is the key to treatment failure of glioma patients. glioma stem cells (GSC) are clone-derived cells of glioma cells^[7]It is the root cause of glioma resistance to radiotherapy, chemotherapy, progression and recurrence^[8]。 Therefore, the development of new targeted blocking GSC resistance pathways and enhancing chemosensitivity have become the main goals of glioma research.

From August 19th to 22nd, 2016, the "2016 National Neurological Injury Conference and the 5th Tiantan National Neurological Trauma Symposium", sponsored by Beijing Tiantan Hospital affiliated to Capital Medical University and co-organized by six academic groups and units, including World Chinese Neurosurgery Association, was held in Beijing. Nearly 500 representatives from all over the country in the fields of neurosurgery, neurocritical care and trauma surgery attended the conference. About 200 papers were submitted to the conference, including 2 papers from academician forums and 5 comments from specially invited experts, of which 96 papers were exchanged at the conference. Professor Liu Baiyun, Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, served as the chairman of the conference; Professor Liu Weiming, Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, served as the executive chairman and presided over the conference.

Sponsored by the Neurosurgery Professional Committee of the Chinese Research Hospital Society and the Neuromedicine Branch of the Chinese Geriatric Society, and undertaken by the Brain Center of the Affiliated Hospital of the Armed Police Logistics College and the Institute of Brain Trauma and Neurological Diseases of the Armed Police Force, the 2016 Neurosurgery Professional Committee of the Chinese Research Hospital Society, the Academic Annual Meeting of the Neuromedicine Branch of the Chinese Geriatric Society and the 13th Neurosurgery Progress Report of the Armed Police Tianjin were held in Tianjin from August 26th to 28th, 2016. More than 500 neurosurgical experts and representatives from more than 20 provinces, municipalities and autonomous regions attended the meeting, and discussed and exchanged views on craniocerebral trauma, cerebrovascular disease, intracranial tumors, functional neurosurgery, pediatric neurosurgery, spinal cord and neurocritical illness, with 38 special reports.