2017年 · 第33卷第04期

At present, stroke is still one of the main disabling and fatal diseases in all countries in the world. According to the Third Retrospective Sampling Survey Report of Causes of Death in China, stroke has become the first cause of death among Chinese nationals, and the mortality rate is 4~5 times that of European and American countries and 3.5 times that of Japan. In the United States, one stroke occurs every 40 seconds and one stroke dies every 4 minutes^[1]。 According to the "China Stroke Prevention and Treatment Report 2015", the overall standardized prevalence of stroke in China is 2.1%, and about 16.4% of people aged ≥40 are at high risk of stroke, and 10% to 15% of strokes are caused by carotid artery stenosis^[2]。 According to this estimate, at least 3.5 million stroke patients in China are caused by carotid artery stenosis. When to undergo carotid revascularization in these patients after stroke has become an urgent clinical problem to be standardized.

Cavernous vascular malformation is a common benign lesion, which most often occurs in the brain parenchyma. Among them, extraparenchymal cavernous hemangiomas (CHs) tend to occur in the cavernous sinus and middle cranial fossa, and are rarer in clinic, accounting for 0.4% ~2.0% of all intracranial vascular malformations. Some can also be seen in tentorium, carina, anterior cranial fossa, cerebellopontine foot, Meckel cavity, sella turcica and internal auditory tract, but are extremely rare, accounting for only 0.2% ~0.5% of intracranial vascular malformations^[1]。 cavernous sinus heman-giomas (CSHs) is a type of CHs, which is easily misdiagnosed as meningioma. Different from intracerebral CA, the clinical manifestations of CHs are similar to those of true hemangioma, and the related clinical symptoms will also be aggravated with the increasing size of hemangioma^[2]。 A total of 6 cases of CSHs were treated by the Head Gamma Knife Center of the Affiliated Hospital of Inner Mongolia Medical University from August 2010 to March 2015, and all of them achieved good results. The retrospective report is as follows.

Hypertensive cerebral hemorrhage is a common disease, and the most common site is putamen. Surgery is the most effective treatment for this disease, but the severe disability rate after operation is extremely high. Minimally invasive technique of directional catheterization is a gradually mature surgical method in recent years, which can not only reduce surgical trauma, but also achieve the purpose of clearing hematoma^[1]。 Magnetic Resonance diffusion tensor Fiber Bundle imaging is a further development of diffusion tensor imaging (DTI), which can determine the damage of moving fibers early^[2]。 Whether soft channel minimally invasive technique can minimize surgical injury and protect the motor fibers of patients is still under discussion. This article retrospectively enrolled 39 patients with hypertensive putamen hemorrhage who completed soft channel minimally invasive surgery and DTI examination from September 2011 to January 2015 in the Department of Neurosurgery, Huzhou Central Hospital, Zhejiang Province. Among them, 32 patients were followed up for 6 months after surgery. The efficacy was compared with 27 patients with hypertensive putamen hemorrhage who underwent craniotomy, DTI examination and 6-month follow-up at the same time.

multiple intracranial aneurysms (MIA) refer to the presence of two or more aneurysms in the cranium at the same time. MIA accounts for 15% to 35% of intracranial aneurysms^[1]。 Because surgical treatment of MIA faces risks such as large exposure range, deep surgical field and more prone to complications, there has been controversy in the treatment strategy. Clipping MIA by one-side approach can reduce the risk and economic pressure brought by secondary surgery on the one hand, but on the other hand, it also increases the risk of primary surgery. Nine cases of bilateral MIA were treated with unilateral craniotomy from June 2013 to February 2016 in the Department of Neurosurgery of North Jiangsu People's Hospital, and good clinical results were obtained. The retrospective analysis is as follows.

With the progress of material science, the interventional treatment of intracranial aneurysms is becoming more and more perfect, especially in the position where craniotomy is difficult to expose its advantages are very obvious, and good microcatheter shaping is one of the key steps in endovascular treatment^[1,2,3]。 There are two technical difficulties in aneurysm embolization: one is that the microcatheter is accurately placed in the aneurysm sac; Another is that during embolization, the tip of the microcatheter needs to maintain good stability to prevent the microcatheter from prolapsing, thus reducing embolization complications^[4]。 The precise shaping of the microcatheter directly determines the success of the operation. The Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, used 3D printing technology to reconstruct the aneurysm complex in three dimensions, analyzed the angle and spatial position of the aneurysm and the tumor-bearing artery, simulated the movement of the microcatheter in the blood vessel, and designed a microcatheter shape model that fits the anatomy of the patient's own aneurysm, which was used to guide the shaping of the microcatheter, thus improving the success rate of operation. Thirteen operations performed in the previous period are summarized.

Non-hemorrhagic subdural effusion is a rare complication after intracranial electrode placement, and its postoperative CT findings are low-density shadows, so it is often overlooked. However, this complication can progress rapidly and even lead to serious complications such as cerebral hernia, which requires early diagnosis and treatment. The Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with non-hemorrhagic subdural effusion in March 2014. Now, combined with relevant literature, the clinical characteristics, diagnostic methods and treatment principles of the disease are summarized, aiming at deepening clinicians' understanding of non-hemorrhagic subdural effusion, so as to diagnose such complications early and improve the prognosis of patients.

Vertebral artery pseudoaneurysm refers to the destruction of the full-thickness structure of the vertebral artery wall, and the blood spills out of the vascular lumen and is wrapped by the surrounding tissue to form an aneurysm. The aneurysm wall has no three-layer structure of the complete artery wall, and is the periarterial tissue or only the residual aortic adventitia^[1]。 In May 2016, a case of right vertebral artery pseudoaneurysm was treated in the Department of Vascular Surgery, Changhai Hospital, Second Military Medical University. The symptoms of right vertebral artery blood stealing and brachial plexus compression were obvious. The hybrid surgical method of right vertebral artery retrograde embolization combined with pseudoarteriectomy + brachial plexus release was used. After the treatment was completed in the first stage, the patient's postoperative symptoms could be relieved and he recovered well. The report is now as follows.

Traumatic internal carotid artery pseudoaneurysm (PSA) is a rare disease. According to foreign reports, the incidence rate of head and neck trauma is about 9%^[1], accounting for about 1% of all intracranial aneurysms^[2]。 There are few reports at home and abroad on local cerebral infarction caused by thrombus shedding in combined tumors.

epidermoid cyst (EC) accounts for no more than 2% of intracranial lesions^[1,2,3,4]It is common in cerebellopontine angle (CPA) area, parasellar, lateral fissure, ventricle and other extracerebral areas, and a few can also occur in the brain or cerebellar parenchyma. EC originating from the brainstem is rare^[1,2,3,4,5]。 There are literature reports abroad that the malignant transformation into squamous cell carcinoma on the basis of cyst^[6]。 However, malignant transformation of brainstem EC has rarely been reported so far. In March 2015, a patient with malignant EC in the brainstem was admitted to the Department of Neurosurgery of Wuxi Second Hospital affiliated to Nanjing Medical University, which is reported in the literature as follows.

optic pathway glioma (OPG) is a low-grade astrocytoma originating from the optic nerve, optic chiasm, optic tract or hypothalamus, which seriously affects the visual acuity and endocrine function of patients^[1]。 Prevalent in children (<18 years old), about 10% of patients were ≥19 years old, and 60% to 75% were female. There is no significant correlation between the prevalent site and age, but it may affect the prognosis. The total mortality rate involving optic nerve is about 5%, while the mortality rate involving hypothalamus is about 50%, and the quality of life of patients is poor^[2]。 Due to the variation of clinical course of OPG and the younger age of patients, the choice of treatment mode is difficult^[3]。 Tremendous progress has been made in the diagnosis and treatment of OPG in the past 10 years, so this article reviews the clinical features and treatment strategies of OPG.

Intracranial aneurysm has the characteristics of high incidence, low rupture rate and high residual mortality after rupture and hemorrhage^[1,2]。 Therefore, the individualized assessment of the rupture risk of intracranial aneurysms has become the most important subject in aneurysm research. Traditional methods of intracranial aneurysm examination, such as digital subtraction angiography (DSA), CT angiography (CTA), magnetic resonance angiography (MRA), etc., are based on the blood flow in the vascular lumen for imaging, and indirectly speculate the risk of aneurysm rupture through information such as the location, size and shape of the aneurysm. This evaluation method is the most widely used clinically, but its accuracy is poor. Histopathological study of intracranial aneurysms showed that there were interruption of endothelial necrosis, necrosis and proliferation of smooth muscle cells and collagen fiber proliferation in the tumor wall^[3,4,5]。 Therefore, a rupture risk assessment method based on aneurysm wall features will be more meaningful.

3D printing technology is a new application technology that combines digital 3D imaging with modern high-tech continuous printing. This new technology has been applied to human production, life and some industrial fields. 3D printing technology plasticizes the characteristics of simulated entities through layered processing, superposition molding and layer-by-layer addition, making it unique in high-precision, high-difficulty and highly complex individualization process. At present, the development of medicine gradually tends to precision treatment, and 3D printing technology is much better than traditional industries, especially in implant manufacturing, in vitro simulation, tissue repair and organ transplantation, showing unique advantages. With the success of 3D printing of organs, cells and bones, 3D printing technology will become an artifact in the medical field^[1,2,3]。 This article reviews the current application and progress of 3D printing in neurosurgery.

Schwannoma is the most common benign tumor in the spinal canal, which is generally single, and multiple ones are rarer. Multiple schwannoma often brings difficulties in clinical diagnosis and treatment because it involves a wide range of nerve and spinal cord segments. Early diagnosis, total resection as much as possible, and maximum protection of nerve function are important factors to improve the curative effect. This article reviews the etiology, clinical features, imaging features, treatment and prognosis of multiple schwannomas in the spinal canal.

Although the mortality rate of aneurysmal subarachnoid hemorrhage (aSAH) has decreased with the advancement of diagnosis and treatment technology, it remains the main factor of stroke-related death^[1]。 At present, the recognized risk factors related to aSAH mortality include poor clinical grade (Hunt-Hess, SAH grade of the World Federation of Neurosurgeons, Fisher score, etc.), elderly patients, aneurysm rebleeding, aneurysm diameter greater than 10 mm and cerebral infarction caused by cerebral vasospasm, among which the direct effect of primary hemorrhage, aneurysm rupture and rebleeding, and cerebral vasospasm are the main factors leading to death after aSAH^[1]。 However, recent studies have found that global cerebral edema (GCE) is another important factor leading to poor prognosis of SAH. This article reviews the research progress of hemispheric swelling after aSAH.

Professor Zuo Huancong, a famous neurosurgeon in China and a famous teacher of a generation, died in Beijing on February 15, 2017 at the age of 72.