2017年 · 第33卷第01期

The brain is the most complex organ of human body, and it is also an extremely sophisticated and perfect information processing system. Its functional connection and working mechanism are major scientific problems and difficulties that scientists have been trying to solve. Brain science, which aims to clarify the working principles and mechanisms of brain and nervous system, is one of the most rapidly developing branches in life sciences and even all natural sciences. The development of brain science has a huge impetus to the prevention and treatment of brain diseases, the development of information and intelligent industries. Because of this, the European Union, the United States, Japan and other countries have successively released their own brain science research plans. In 2016, China also released "China Brain Project: Brain Science and Brain-like Research"^[1]。 In the brain science research oriented to clinical needs, neurosurgery should actively participate in China's "Brain Project", which will help China make breakthroughs in the research fields of brain cognitive neurological basic principles, brain-like research and the level of diagnosis and treatment of major brain diseases^[2,3]。

Spontaneous intracerebral hemorrhage (SICH) refers to intraparenchymal hemorrhage caused by spontaneous rupture of intracranial large, small arteries, veins and capillaries caused by various causes under non-traumatic conditions. SICH is the most serious type of acute cerebrovascular disease, with acute onset, dangerous condition and high mortality rate. In European and American countries, SICH accounts for about 15% of all strokes; Domestic epidemiological investigation showed that the incidence of SICH accounted for 17.1% ~55.4% of stroke, which was significantly higher than that in foreign countries^[1]。 The occurrence of SICH is caused by the combination of environmental and genetic factors, among which hypertension is the most important cause, accounting for about 50% or more of all SICH. The incidence of SICH caused by hypertension in China is increasing year by year, and it is more frequent and younger. Followed by amyloid angiopathy, accounting for about 15% ~30%; Other causes and unknown causes account for about 10%.

In September 2016, the Brain Trauma Foundation announced the Guidelines for the Treatment of Severe Craniocerebral Trauma (Fourth Edition), which will be published in Neurosurgery^[1], has attracted the attention of academic circles at home and abroad. The new version of the guidelines was published 7 years later than the third edition. With stricter evidence-based medicine standards, 94 new research results were included as evidence, and more accurate treatment recommendations and problem solutions were put forward. There are also changes in views in the new version of the Guide on some controversial issues. Combined with the treatment status and problems of severe craniocerebral injury in China, this paper explains the important issues involved in the fourth edition of the guide, in order to improve the treatment level of craniocerebral injury in China.

More than 50% of spontaneous supratentorial cerebral hemorrhage is located in the basal ganglia area, and the disability rate and mortality rate are high^[1]。 Although there are many surgical methods, because of the deep location, the damage to brain tissue is inevitable, and the postoperative complications and prognosis are also different^[2,3]。 Dye et al.^[3]It has been reported that endoscopic removal of hematoma can reduce trauma, but the removal rate of hematoma is not satisfactory. At present, there are few cases of endoscopic clearance of intracerebral hematoma guided by neuronavigation in China. From June 2014 to April 2015, the Department of Neurosurgery, Dong' e County People's Hospital, Liaocheng City, performed endoscopic clearance of hematoma in basal ganglia area under the guidance of neuronavigation combined with brain retractor. The surgical effect was good, which is reported as follows.

Intracranial aneurysm rupture is the first cause of subarachnoid hemorrhage (SAH). Studies show that the incidence of intracranial aneurysms is 3.6% ~6%^[1]Wherein the fracture rate is 1% to 2%^[1]。 SAH leads to various pathological changes such as cerebral vasospasm, cerebral edema, cerebral infarction and hydrocephalus, and the mortality rate is as high as 25% ~60%. If patients after the first bleeding are not treated in time and correctly, 40% of patients will rebleed within 3 weeks, and the mortality rate of rebleeding is as high as 80%^[2]。 At present, the common practice is to judge the prognosis of patients and whether to undergo surgical treatment according to the Hunt-Hess classification of patients. However, the recent European Stroke Organization management guidelines on aneurysms and SAH recommend that the prognosis on admission of aneurysmal subarachnoid hemorrhage (PAASH grade) should be used to assess the prognosis of aneurysmal SAH (aSAH)^[3]。 In this study, the clinical data of 138 patients with aSAH treated by surgery were retrospectively analyzed to explore the related factors affecting the prognosis of aSAH patients.

Internal carotid artery injury is a relatively rare complication of transphenoidal pituitary adenoma surgery, but its consequences can be catastrophic. Two cases of internal carotid artery injury caused by transsphenoidal pituitary adenoma surgery were treated in Qilu Hospital of Shandong University (Qingdao) from March 2015 to January 2016. The reports are as follows.

Acute epidural hematoma is a common intracranial hematoma in neurosurgery, accounting for about 30% of intracranial hematomas. It is extremely rare for the hematoma to dissipate without surgical treatment within 24 h^[1,2,3,4]At present, 13 cases have been reported in domestic and foreign literatures^{[2,5,6,7,8,9,10,11,12,13,14,15]}, including 10 cases abroad. Most scholars believe that the mechanism of its dissipation is due to the existence of skull fracture, and its hematoma penetrates under the scalp through the fracture line and redistributes^{[5,6,7,8,9,10,11,12,13,14,15]}。 The clinical data and treatment effect of a patient with multiple acute epidural hematoma admitted to the Department of Neurosurgery of Qiannan People's Hospital in September 2015 are reported below.

PatientFemale, 76 years old. He was admitted to hospital due to weakness of both lower limbs for 1 year and aggravated for more than 10 days. Physical examination: the muscle strength of both upper limbs was grade V, the muscle strength of left lower limbs was grade I, and the muscle strength of right lower limbs was grade 0. The double Pap sign was not drawn out, and the pain under both costal arches was reduced. MRI suggests T_5～7Epidural space occupying lesions in the vertebral canal at vertebral level (Figure 1)。 Posterior median approach was used for surgery, T_5～7At the level of the vertebral body, a gray-red lesion with soft texture and clear boundaries could be seen in the epidural of the vertebral canal, containing fat, blood vessels and fibrous tissue. There was no obvious adhesion to the dura, and the blood supply was abundant, so it was totally resected. The postoperative pathological diagnosis was angiolipoma (Figure 1)。

With the in-depth study of skull base surgery by endoscopic endonasal approach (EEA) and the continuous improvement of surgical instruments, the technique of skull base surgery in EEA has been continuously improved, the exposure range of skull base has gradually expanded, and the types of lesions that can be resected by endoscopy have gradually increased. Correspondingly, the range of skull base defects caused by surgery increases, and the risk of postoperative cerebrospinal fluid leakage, intracranial infection and encephalocele increases, which become the main factors restricting skull base surgery in EEA. Therefore, the skull base reconstruction technique appears to be crucial. Small-scale skull base defects can be reconstructed with artificial dermis, free tissue flap and other free repair materials, and the success rate is more than 95%^[1,2]。 Endoscopic enlargement of skull base defects caused by transnasal approach has a high incidence of cerebrospinal fluid leakage after reconstruction with free repair materials^[3]More reliable reconstruction techniques are needed. In recent years, the main progress is the application of mucosal flap with vascular pedicle in the nasal cavity for skull base reconstruction, which reduces the incidence of cerebrospinal fluid leakage to less than 5%^[4]。 This article reviews the application of these pedicled mucosal flaps in EEA skull base surgery.

Intracranial aneurysm is a tumor-like protrusion caused by local intracranial vascular abnormalities. It mostly occurs at the bifurcation of intracranial arteries. Due to the lack of smooth muscle cells in the aneurysm wall, it is easy to rupture, resulting in subarachnoid hemorrhage (SAH). The overall mortality rate of aneurysm SAH is about 50%^[1,2]。 According to the epidemiological research on unruptured intracranial aneurysms in China, the incidence rate of intracranial aneurysms in China is about 7%, which is higher than that in other countries in Europe and America^[3]。 However, the etiology of intracranial aneurysm is still unclear. At present, it is believed that intracranial aneurysm is a complex disease that occurs under the combination of congenital genetic factors and acquired environmental factors^[4]。 With the further development of high-throughput whole genome sequencing (WCS), genome association study and whole genome-based gene expression analysis technology, it provides a powerful means for exploring the genetic risk factors and molecular basis of intracranial aneurysm. This article will review the latest research progress of molecular basis and genetics of intracranial aneurysms, in order to provide more recent information for molecular biology and genetics research of intracranial aneurysms.

neurofibromatosis type 2 (NF2) is an autosomal dominant disease with more than 95% of bilateral acoustic schwannomas. As the disease progresses, most NF2 patients will eventually face complete bilateral hearing loss^[1]。 Due to the impaired integrity of the auditory nerve, it is generally difficult for patients to perform hearing reconstruction by cochlear implant (CI). auditory brainstem implant (ABI) can bypass the cochlea and auditory nerve to establish new auditory pathways. It is suitable for deaf patients with impaired auditory nerve integrity or cochlear dysfunction. It is the only way for the vast majority of NF2 patients to reconstruct their hearing^[2]。 This article reviews the application of ABI technique in type 2 neurofibromatosis.

Epilepsy is a disorder of brain function caused by abnormal hypersynchronous discharge of brain cell groups, which can be accompanied by sensory, motor, cognitive, conscious and mental disorders. There are nearly 50 million epileptic patients worldwide, and the prevalence of epilepsy in Mainland China is 3.6‰ ~7.0‰^[1]。 About 1/3 of these epileptic patients cannot be treated with drugs, but need neurosurgical treatment. Studies have shown that neurotransmitter dysregulation, inflammatory response and ion channel dysfunction are all related to the pathogenesis of epilepsy, and the complex pathogenic mechanism leads to the difficulty and complexity of epilepsy treatment^[2]。 This article reviews the role of inflammatory response in the pathogenesis of epilepsy as follows.

Alzheimer's disease (AD) is a progressive neurodegenerative disease with memory impairment as the main manifestation and insidious onset. The disease is also clinically manifested as language impairment, cognitive dysfunction, personality disorder and behavioral changes. The incidence of AD increases approximately exponentially with age. There were about 35.6 million AD patients worldwide in 2010, and it is expected to increase to 115.4 million people in 2050. In 2005, there were about 5.98 million AD patients in China, which will reach 10.2 million in 2020 and 22.5 million by 2040, making it the largest country with AD^[1]。