2017年 · 第33卷第05期

Since the existence of human beings in history, the relationship between disease and human beings has been continuously explored, as well as the impact of medical models on human beings and diseases. From the occurrence and development of diseases to the history of human fighting against diseases, it clearly shows the characteristics of medical models in different eras and the transformation of disease diagnosis and treatment models under their influence.

Intracranial primary germ cell tumor is the most common germ cell tumor, accounting for about 70% ~80% of intracranial primary germ cell tumor, and mostly occurs in the pineal region, sella turcica region, hypothalamus, basal ganglia and other parts^[1]。 Germ cell tumors occurring in the brainstem are very rare^[2]Because brainstem germ cell tumors lack specific symptoms and signs, preoperative diagnosis is very difficult. Germ cell tumors are extremely sensitive to radiotherapy and chemotherapy, and the purpose of surgery is to take a biopsy to confirm the diagnosis^[3,4]。 There is a rich conduction system in the brainstem, as well as numerous nerve nuclei; The entire brainstem is staggered with a reticular structure, which is "filled" with uneven density of neurons. It is an important plant regulatory center, regulating functions such as cardiac activity, circulation and respiration, and sending impulses to the cerebral cortex to maintain intact consciousness. Based on these characteristics, the brainstem was once considered a restricted area for surgery until 1971, when Lassiter et al.^[5]It is proposed for the first time that brainstem lesions can be treated by surgery. Although various surgery-related adjuvant techniques have greatly improved the success rate of brainstem surgery in recent years, there are still many surgery-related complications. For germ cell tumors at the brainstem site, complications caused by excessive resection can be consciously prevented if the diagnosis can be made accurately before surgery. There are few literature reports of this disease at home and abroad, including 3 cases described in this article. So far, there are 23 cases of germ cell tumor originating from the brain stem site reported in the literature. This article retrospectively analyzed three patients with germ cell tumors originating from the brainstem admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from October 2012 to February 2016. Their clinical data, imaging features, pathological manifestations, treatment methods and prognosis are reported as follows.

Intracranial arachnoid cysts (AC) are a kind of benign lesions related to cerebrospinal fluid in the arachnoid membrane. Most of them are found accidentally by imaging and have no clear clinical symptoms^[1,2]。 After AC combined with subdural hematoma, it often presents with intracranial hypertension and focal neurological symptoms. Clinically, the cases of AC combined with subdural hematoma are relatively rare, its pathogenesis is still unclear, and the treatment method is also controversial. From January 2010 to October 2016, 426 children with AC were diagnosed by imaging examination in the Department of Neurosurgery, Beijing Children's Hospital affiliated to Capital Medical University, of which 5 cases were complicated with subdural hematoma. This study retrospectively analyzed the clinical data, treatment methods and prognosis of these 5 children with AC complicated with subdural hematoma, and analyzed it in combination with relevant literature for clinicians' reference.

neurofibromatosis type 1 (NF1) complicated with pleural meningocele is relatively rare in clinical practice, and other diseases such as brainstem glioma have also been reported^[1]Spinal ependymoma^[2]。 The incidence of NF1 in patients with pleural meningocele is unknown. A few patients see a doctor with dyspnea as the first symptom, and are easily misdiagnosed as thoracic tumor or mediastinal tumor^[3,4]。 From March to June 2016, 3 patients with NF1 complicated with pleural meningocele were treated in the Department of Neurosurgery, Union Hospital affiliated to Fujian Medical University. Now, the surgical treatment of such cases is discussed in combination with relevant literature at home and abroad.

atypical teratoid/rhabdoid tumor (AT/RT) is a kidney-like rhabdoid tumor. It is a rare and highly malignant tumor of the central nervous system composed of rhabdoid cells, primitive neuroectodermal cells with interstitial and epithelial components^[1]。 The disease occurs mainly in infants and children, and more than half of the tumors are located in the posterior cranial fossa (especially the cerebellopontine angle). An adult sellar area AT/RT was admitted to the Department of Neurosurgery, Affiliated Hospital of Southwest Medical University in November 2015. A simultaneous search of PubMed and Medline reported a total of 7 such cases from 1985 to 2015 (Table 1)^[2,3,4,5,6], and review its literature.

myeloid sarcoma (MS), also known as extramedullary myeloid tumor, granulocytic sarcoma or chloroma, is a mass that occurs at an anatomical site outside the bone marrow and consists of myeloid blasts with or without signs of maturation^[1,2]。 1988 Davey et al.^[3]To propose the concept of extramedullary medullary tumor, which includes mass-forming granulocytic sarcoma and leukemic extramedullary infiltration. MS can be divided into isolated and leukemic. Among them, leukemic MS can cause extramedullary infiltration in many parts of the body, but it is rare to occur in the spinal canal. A patient with chronic myelogenous leukemia (CML) complicated with MS was admitted to the Department of Neurotumor Surgery of the First Hospital of Jilin University in March 2015. The review literature is reported below.

A patient with oculomotor nerve paralysis was admitted to the Department of Neurosurgery of Jinan Military Region General Hospital, and was diagnosed as oculomotor perineural cyst by pathology. Searching the relevant literature at home and abroad, no similar cases were reported. The diagnosis and treatment results are reported as follows.

Children's brain stem glioma accounts for about 10% ~15% of children's brain tumors^[1]。 Among them, 15% ~20% are low-grade gliomas, showing chronic development process and good chemotherapy sensitivity; The majority of the remaining 80% are mass occupants of diffuse infiltrating pons and are designated as diffuse endophytic pons gliomas (diffuse intrinsic pontine gliomas, DIPG); Non-DIPG high-grade glioma of the brainstem in children has low incidence and poor prognosis. DIPG is the main cause of death in children with brain tumors. The overall survival (OS) is 8 to 11 months, the progression-free suivival (PFS) is 5 to 9 months, and the survival rate is 2 years<10%^[2]The length of the patient's disease course and Karnofsky functional status score correlated with the prognosis of children with DIPG^[3]。 From 1984 to 2005, no survival benefit was found in traditional cytotoxic chemotherapy for DIPG. Since 2005, there have been many new advances in the basic and clinical research of brainstem glioma in children, which has opened a new era for the chemotherapy research of brainstem glioma. This article reviews the clinical chemotherapy, the problems faced by chemotherapy research and the research progress of brainstem glioma in children.

intracranial arterial dolichoectasia (IADE), also known as dilated cerebral arteriopathy, is characterized by the enlargement of at least one intracranial artery in length and diameter, and the affected intracranial artery is dilated and prolonged, sometimes even meandering^[1,2]。 Up to 12% of IADE patients have a history of stroke. The main clinical manifestation of IADE is ischemic stroke, and patients can develop severe neurological deficit symptoms and even die^[1,2]。 To date, no randomized controlled trials of IADE treatment have been reported and, therefore, there is no high-quality clinical evidence available for treatment guidelines. At present, the choice of IADE treatment depends on the patient's clinical presentation and the severity of the disease. Specific methods include blood pressure control, antithrombotic therapy, endovascular therapy, and craniotomy. At present, it is necessary to better assess the incidence of IADE in the general population, establish an epidemiological database of the disease, identify life-threatening complications, and find effective treatments. In this paper, the diagnosis, epidemiology, clinical characteristics, prognosis and treatment of IADE are reviewed.

spinal cord injury (SCI) is a disease with high disability rate and often accompanied by serious complications. Preliminary analysis shows that adolescent SCI is mostly due to traffic accidents and falls from heights; The main causes of young adults' injuries are traffic accidents, falling from height and smash injuries; Traffic accidents and fall injuries are common causes in the elderly. With the development of world economy, the incidence of SCI shows an obvious increasing trend. In developed countries, the annual incidence rate of SCI is 13.3~45.9/1 million. There is no national statistics in China, but there are many local statistics. Among them, the incidence rate of SCI in Beijing in 2002 was 60/1 million^[1]； Statistics from 2004 to 2008 in Tianjin showed that the annual incidence rate of SCI was 23.7/1 million^[2]。 According to a report published by the World Health Organization, the number of SCI occurs worldwide can reach 500,000 every year^[3]。 Therefore, the preparation of SCI animal models is of great significance to study the pathophysiology, neurochemical mechanism and clinical treatment of SCI. Since Allen^[4]The method of heavy objects falling and hitting animal vertebrae has pioneered the preparation of SCI animal models. After continuous improvement and innovation, the types of SCI models have been quite diverse. The author summarizes the current situation of SCI animal models at home and abroad, hoping to provide reference for the development and use of SCI animal models.

A series of far-field evoked potentials, including short incubation period potential (≤10 ms) and medium-long incubation period potential (>10 ms), were recorded in the scalp by stimulating the facial distribution area of the trigeminal nerve and the trigeminal nerve fibers. These evoked potentials belong to a kind of somatosensory evoked potentials. Short incubation period potentials are also known as brainstem trigeminal evoked potentials (BTEPs) or early trigeminal evoked potentials^[1,2]It is a reliable electrophysiological index to evaluate the trigeminal nerve fiber bundle, trigeminal nerve nucleus and its central conduction pathway^[3]。 However, because BTEP is susceptible to myoelectric interference, the puncture of stimulating electrode requires high accuracy, and it needs to be directly punctured into the supraorbital foramen, infraorbital foramen and mental foramen to stimulate the supraorbital nerve, infraorbital nerve and mental nerve. The puncture is difficult, which restricts its clinical research and development. This article summarizes its monitoring methods, origin, application, shortcomings and prospects in trigeminal neuralgia as follows.

Glioma is the most common intracranial malignant tumor. After decades of joint efforts by scholars in related fields, people's understanding of glioma has been continuously improved. The imbalance of glutamate homeostasis and the increase of extracellular glutamate concentration in the central nervous system are one of the important factors involved in the growth and invasion of glioma, which has become the research hotspot in recent years. This article discusses the relationship between glutamate metabolism and glioma and the related therapeutic progress, so as to provide reference information for clinical glioma drug development and clinical treatment.

The myelinated nerve fibers that form myelin structure are essential for the rapid jumping conduction of action potentials. They are formed by the interaction of Schwann cells, axons and basement membranes in the peripheral nervous system, and the whole development process is strictly regulated. Any abnormality in the link may lead to myelination disorder or myelin structure abnormality, thus leading to corresponding peripheral neuropathy. In addition to insulating and protecting nerve axon, myelin sheath can also provide a structural foundation for long-distance nerve impulse jumping conduction, and have a nutritional support effect on nerves, thus promoting damage repair. This article mainly reviews the process of myelin formation of peripheral nerve in vivo, the main components involved in myelin formation and the signal pathways between them, and the research on the establishment of peripheral nerve myelin model.