2017年 · 第33卷第02期

Pituitary adenomas are common intracranial benign tumors of monoclonal origin of adenopituitary cells, accounting for about 7% of intracranial tumors, and are divided into functional pituitary adenomas and non-functional pituitary adenomas. Except for some specific types of tumors and populations, the treatment of pituitary adenomas is mainly surgical. The main goals of surgical treatment were satisfactory tumor resection, adequate decompression and postoperative endocrine relief. The surgical methods included microscopic craniotomy and neuroendoscopic transnasal sphenoidal sinus surgery^[1]。

Intraspinal tumors account for approximately 15% of CNS tumors, while schwannomas account for approximately 25% of intraspinal tumors. Spinal schwannomas are mostly single, and can occur in all segments of the spinal canal. The peak incidence is between 40 and 60 years old, and most of them originate from the dorsal nerve root^[1]。 For the treatment of spinal schwannoma, total laminectomy was the main treatment in the past, but this procedure caused greater damage to the posterior column structure of the spine. Since then, it has gradually developed to apply hemilaminary surgery, and obtained a good prognosis. However, for smaller schwannomas located between laminar segments, surgery (semi-semi-laminar approach) by enlarging the natural space between adjacent laminas can better maintain the stability of the bone structure of the spinal canal and facilitate total resection of the tumor. From January 2010 to June 2015, 18 patients with spinal schwannoma were treated in the Department of Neurosurgery of Jinan Military Region General Hospital, and they were treated with semi-semi-laminar approach, and satisfactory results were achieved, which are reported below.

Atherosclerosis is the main cause of coronary heart disease and cerebrovascular disease. In patients with coronary atherosclerosis, angina pectoris, myocardial infarction, arrhythmia, and even sudden death can occur if the diameter of the tube is narrowed by more than 75%; Cerebral atherosclerosis can cause cerebral ischemia, cerebral atrophy, or cerebral vascular rupture and hemorrhage. Coronary artery stenosis and carotid artery stenosis can exist simultaneously. According to statistics, about 12% ~17% of patients who plan to undergo coronary artery bypass grafting have carotid artery stenosis>50%; While 66% ~77% of patients with carotid artery stenosis were complicated with coronary heart disease, 28% of them needed coronary artery bypass grafting^[1,2]。 The results showed that coronary artery stenosis and carotid artery stenosis had a significant correlation, and carotid artery stenosis had a tendency to worsen as the degree of coronary artery stenosis progressed^[3]。 Therefore, it is essential to develop a surgical protocol for patients with coronary stenosis combined with carotid stenosis. This article reports the clinical data of 3 patients with coronary artery stenosis combined with carotid artery stenosis admitted to the Department of Cardiac Surgery of the Second Hospital of Hebei Medical University from March 2014 to October 2015, and discusses the treatment experience.

Autologous bone flap has the advantages of satisfactory shape, less immune rejection, low cost and easy acceptance by patients^[1,2], is considered an ideal repair material for skull defects^{[3,4,5,6,7,8,9,10]}。 Bone flap resorption is one of the main complications after autologous cranioplasty, and its incidence varies greatly in the literature reports^{[11,12,13,14,15,16,17,18,19,20]}。 At present, the lack of uniform diagnostic criteria for bone flap resorption after autologous cranioplasty is the main reason for the large difference in the incidence of bone flap resorption reported by various researchers^{[14,15,16,17,18]}。

Brainstem hemorrhage caused by hypertension, sudden onset, dangerous condition, often secondary to multiple complications, resulting in a high mortality rate of patients^[1]。 At present, because of the difficulty and high risk of surgery, conservative treatment is mostly adopted in clinical practice, and it is even considered as a contraindication^[2,3]。 This article retrospectively analyzed the clinical outcomes of 22 patients with severe hypertensive brainstem hemorrhage [Glasgow Coma Score (GCS) ≤8] operated from June 2007 to March 2015 in the Department of Neurosurgery of Suqian People's Hospital of Nanjing Drum Tower Hospital Group, and compared with 24 patients treated conservatively at the same time.

bronchogenic cyst (BC) is a relatively rare congenital disease, which is common in children and mostly occurs in the mediastinum. BC can also occur in gastrointestinal tract, pericardium, sternum, subcutaneous and other parts, so its clinical manifestations are diverse^[1]。 spinal bronchogenic cyst (SBC) occurring in the spinal cord is more rare, only 17 cases have been reported so far^{[2,3,4,5,6,7,8,9,10,11,12,13,14,15]}。 In October 2015, a patient with SBC was admitted to the Department of Neurosurgery of Shanxi Provincial People's Hospital. The pathogenesis and clinical characteristics of SBC were summarized and discussed in combination with previous literature.

Paraganglioma is a neuroendocrine tumor, which occurs in the adrenal medulla, head and neck, retroperitoneal paravertebral areas, etc. Paraganglioma occurring in the spinal canal is rare clinically, and paraganglioma occurring in the cauda equina area is even rarer^[1,2,3,4,5]。 Due to the lack of specific clinical and imaging findings, it is easy to misdiagnose before surgery. In March 2016, the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University admitted a patient with paraganglioma in the cauda equina region of the spinal canal confirmed by pathological examination. The results of surgical treatment are satisfactory. The MRI characteristics and diagnosis and treatment experience of intraspinal paraganglioma are summarized as follows in combination with literature review.

Adolescents refer to a special group of people aged 15 to 18 years old, whose incidence of intracranial aneurysms is low. Distal intracranial aneurysm mainly refers to a type of aneurysm located at the distal end of the artery away from the Willis ring, the internal carotid artery, the main vertebrobasilar artery, and the main middle cerebral artery. The incidence rate accounts for 2% ~5.5% of intracranial aneurysm^[1,2]。 Among them, juvenile intracranial aneurysms are not located in Willis ring, and are located at the distal end of intracranial artery is extremely rare. There are few relevant literature reports at home and abroad, and occasional case reports^[3]Therefore, its exact incidence has not been reported. From January 2013 to January 2014, two adolescent patients with distal intracranial aneurysm were treated in the Department of Neurosurgery of Ganzhou People's Hospital. The diagnosis and treatment experience is reported as follows.

Case 1 male, 53 years old; Originally from Inner Mongolia, Mongolian. He was admitted to Xing' an League Hospital in Ulanhot on November 7, 2014 due to "pain in the left side of his face for 1 year and aggravated for half a month". One year ago, the patient developed left facial pain without obvious trigger. The pain was paroxysmal electrocautery-like and intolerable. It attacked more than 10 times a day, each time lasting for several seconds to several minutes and then stopped. After oral analgesics, the symptoms were slightly relieved. There were no symptoms such as dizziness, nausea and vomiting, tinnitus, hearing loss and limb twitching. The pain has worsened in the past half month, and the effect of oral carbamazepine and other drugs is not good. Afraid of eating and brushing teeth for fear of pain. When he was young, he had a history of eating pork with cysticercosis, and he always liked to eat lettuce. He had a history of cerebral cysticercosis for 4 years, and his symptoms were relieved after oral medication. Physical examination: clear consciousness, fluent speech, slight reduction of pain in the left side of the face, pain trigger point, normal muscle strength, muscle tone and tendon reflex of limbs, no pathological signs, no meningeal irritation signs. Cerebrospinal fluid pressure at lumbar puncture was 170 mmH₂O, the number of nucleated cells in CSF was 74×10⁶/L, the biochemical test was normal. Cysticercosis antibodies were (+) in both serum and CSF. CT of the head showed multiple cystoid foci and calcification foci in the brain; MRI showed multiple cystic abnormal enhancement foci in the anterior longitudinal fissure cistern, left lateral fissure, left cerebellopontine foot subarachnoid space, and both parietal lobes (FIG. 1A,FIG. 1B,Figure 1C)。 Imaging and medical history diagnosed mixed cerebral cysticercosis and secondary trigeminal neuralgia caused by subarachnoid cerebral cysticercosis. Paratrigeminal cysticercosis removal, trigeminal nerve release and microvascular decompression were given. During the operation, the arachnoid was thickened, the arachnoid was cut open, and the appearance and color of the nerve were normal. The root of the trigeminal nerve formed a noose due to the thickening of the arachnoid and the adhesion of cysticercosis-like substances, and the posterior inferior cerebellar artery was pulled to compress the nerve root, and the cysticercosis-like necrotic substances were removed. Thoroughly release the perineural adhesion, free the trigeminal nerve root, release the nerve entrapment caused by the arachnoid adhesion noose and posterior inferior cerebellar artery, and pad the polyester gasket on the trigeminal nerve root, and the postoperative symptoms disappear. Lumbar puncture was treated 3 times, no infection, cured and discharged. Because cysticercosis was still present in other brain lobes, intestinal worm clearing was administered orally for 10 d. Pathological findings showed that there was a small infiltration of lymphocytes in the degenerated tissue (Figure 1D), considering the degeneration and necrosis of cerebral cysticercosis, the formation of necrosis and arachnoid adhesion to form a noose, pulling the posterior inferior cerebellar artery, and entraping the root of the trigeminal nerve to form trigeminal neuralgia.

Glioma is the most common primary neuroepithelial tumor in the cranium. According to the 2007 WHO classification of central nervous system tumors, grade I and II are low-grade gliomas, and most of adults are grade II gliomas, mainly including astrocytoma, oligodendroglioma and oligodendroastrocytoma^[1]。 Although low-grade glioma grows relatively slowly, it has a tendency to relapse and transform into high-grade glioma, and there is a high clinical disability and mortality rate. Low-grade glioma mainly occurs in young and middle-aged people aged 30-45 years, and their prognosis is quite different. The median survival time is 5-12 years, and it can be extended to about 20 years after effective treatment^[2]。 Therefore, in the treatment strategy, in addition to delaying the tumor growth rate, prolonging progression-free survival and overall survival as much as possible, we should pay more attention to improving the quality of life of patients after treatment. Maximizing safe resection is an important initial treatment for low-grade glioma. On this basis, the adjuvant therapeutic role of radiotherapy has been clearly defined. However, the clinical status of adjuvant chemotherapy is still open to debate, and high-level clinical evidence-based medicine research is urgently needed. This article aims to briefly review the application status and research progress of adjuvant chemotherapy for low-grade glioma.

chordoma is an invasive tumor originating from the residual chordal tissue in the embryonic period. It grows slowly and is low to moderately malignant. The incidence rate is less than 1 in 1 million. It can occur at any age, ranging from 1 to 80 years old, but mainly occurs at 40 to 60 years old. The primary sites of chordoma were mainly in sacrum (50% ~60%), skull base (25% ~35%) and spine (5%)^[1,2]。 Chordoma accounts for 1% to 4% of primary malignant bone tumors, and the overall incidence rate is more in males than in females, about 1.5: 1.0 to 2.0: 1.0. The pathological types of chordoma include classical type, chondroma-like type and undifferentiated type^[2,3,4]。 Chordomas mostly show slightly high density or mixed density shadows on imaging, with bone destruction in the slope, sellar area or other tumor areas, and tumor tissue showing honeycomb changes^[4,5,6,7]。 The treatment of chordoma is mainly surgical resection^[4,8,9]However, incomplete surgical resection, high postoperative disability and recurrence rate, and long-term postoperative complications seriously affect the quality of life of patients, so postoperative adjuvant chemoradiotherapy is necessary^[4,9]。 However, because most tumors are close to some important structures, radiotherapy can control the growth of tumor tissues, but also have irreversible effects on the surrounding normal tissues, and the tumors are insensitive to radiotherapy, so the application of radiotherapy is also limited^[10,11]。 With the deepening of research, the progress of controlling chordoma with drugs has gradually become a new treatment mode. At present, people's understanding of chordoma has entered the molecular field, and it has been found that the occurrence of chordoma is mainly related to gene mutation, which may be the change of multiple genes. At present, the reported chromosome deletion and mutation of chordoma mainly occur in lq36 and 7q33. Chordoma cells can express a variety of genes of interest, mainly including stem-cell factor receptor (C-KIT), platelet-derived growth factor receptors (PDGFR), tyrosine kinase receptors (receptor tyrosine protein kinase, RTKs) and epidermal growth factor receptor (EGFR), etc^[12,13]。 This article reviews the recent types of drugs in the treatment of chordoma and the progress of specific drugs.

Meningioma is one of the most common central nervous system tumors, accounting for about 24% ~30% of primary central nervous system tumors in adults, and the annual incidence rate is about 13/100,000^[1]。 Meningiomas originate from cap-shaped cells of arachnoid granules. According to the classification criteria proposed by the World Health Organization (WHO), meningiomas can be classified into three grades according to histological type: benign (WHO grade I), atypical (WHO grade II) and malignant/anaplastic (WHO grade III), among which grade I meningiomas account for more than 80% of all meningiomas. Histological types of meningiomas are diverse, and multiple histological types can occur in a single meningioma^[2]。 Most meningiomas are benign, and the clinical manifestations are mainly caused by the compression and space-occupying effects of the tumor, such as headache, epilepsy, focal edema, etc. However, skull base meningioma often causes severe symptoms because it is adjacent to important anatomical structures. For example, sellar meningioma can compress the optic nerve and cause visual impairment and visual field defect. Cerebellopontine angle meningioma causing damage to the auditory or facial nerves; Petroclinal meningiomas are located near the brainstem and basilar arteries, which may be life-threatening. Although most meningiomas can be completely removed by surgery and have a good prognosis, there are still great challenges in the treatment of some skull base meningiomas, multiple meningiomas and high-grade meningiomas. Due to the limitation of surgical treatment of meningioma, it is urgent to study new therapies such as molecular targeted therapy^[3,4]。 In recent years, with the continuous progress of molecular biology technology, the academic community has a deeper understanding of the molecular biology mechanism of meningioma pathogenesis. In this paper, the research achievements on the molecular biological mechanism of meningioma in recent years are reviewed as follows.

susceptibility weighted imaging (SWI) is a newly developed magnetic resonance contrast-enhanced imaging technology in recent years, which was first developed by Haacke et al^[1]Invented in 1997, it was initially called "high-resolution blood oxygen level-dependent vein imaging". It was renamed "sensitivity-weighted imaging" in 2004 because it can reflect more information about the magnetic sensitivity of substances^[2]。 In recent years, through the application of high-field magnetic resonance apparatus and the continuous improvement of related technologies, its clinical application scope has been expanded. SWI is mainly used for the display of intracerebral microhemorrhage and microveins^[3,4]In addition to the deficiencies of venulous display in previous images, domestic and foreign studies have gradually paid attention to the application of SWI in intracranial tumors.

Epilepsy is a group of chronic and paroxysmal brain dysfunction caused by excessive abnormal discharge of neuronal cell populations in the central nervous system. At present, about 1% of the world's population is affected by epileptic seizures, among which the prevalence of epilepsy is about 5‰ ~7‰ in foreign countries, and about 0.33% ~0.58% in China^[1]。 Although it can be effectively treated with antiepileptic drugs in the early stage, more than 20% of patients still develop stubborn resistance to drugs and eventually develop refractory epilepsy. In recent years, an emerging technology "optogenetics" has been gradually applied to the treatment of epilepsy. This technology is based on the combination of optics and genetics. By constructing photosensitive protein gene vectors and expressing them in specific neuronal regions, exogenous light irradiation with different wavelengths is used to accurately excite or inhibit neuronal activity^[2]。 Application of optogenetic techniques to epilepsy has made significant achievements recently. Researchers can use this technology to target and regulate specific neuronal regions in epilepsy animal models, and this technology has the advantages of efficient time and space accuracy, and effectively controls the onset of epilepsy^[3]。 However, optogenetic technology still uses virus as vector to construct photosensitive protein gene expression vector. Due to the inherent toxicity, immunogenicity and potential tumorigenicity of viral vectors, there are certain biosafety risks^[4]。 Therefore, it is necessary to develop a novel vector as a targeted delivery tool for photosensitive protein genes. Because of its simple preparation process, excellent photothermal stability and good biocompatibility, nanometer copper sulfide can efficiently penetrate the blood-brain barrier, and targeted enrichment in tumor cells, which has low toxic and side effects on surrounding normal tissue cells^[5]。 In addition, the researchers processed, modified and improved copper sulfide to prepare a novel nanocarrier widely used in biomedical field^[6]。 This paper first summarizes the pathogenesis of epilepsy, at the same time, introduces the research and application of optogenetics and photothermal therapy in the diagnosis and treatment of epilepsy and tumor respectively, and discusses and prospects the nanomaterial copper sulfide as a new carrier combined with photothermal therapy in the treatment of epilepsy.

arachnoid cyst (AC) is formed by the accumulation of cerebrospinal fluid in the intra-and subarachnoid spaces of the cistern or brain fissure. Intracranial AC was first reported by Bright in 1831 and accounts for approximately 1% of intracranial space-occupying lesions^[1,2]。 Children account for about 60% to 90% of patients with AC^[3]It is often found accidentally during cranial imaging examination after brain trauma. With the development of imaging technology, the diagnostic rate of AC has improved. At present, there are still controversies about its pathogenesis and surgical indications. This article summarizes the literature at home and abroad in recent years, and summarizes the pathogenesis, clinical characteristics and treatment modes of AC.