2017年 · 第33卷第06期

Moyamoya disease is a kind of cerebrovascular disease with unknown etiology, characterized by chronic progressive stenosis or occlusion of the ends of bilateral internal carotid arteries and the initiation of anterior cerebral arteries and middle cerebral arteries, and secondary to the formation of abnormal vascular network at the skull base. In 1969, by Japanese scholars Suzuki and Takaku^[1]First reported. Because this abnormal vascular network of the skull base resembles "smoke" on cerebral angiography images, it is called "moyamoya disease". Smoky vessels are dilated perforating arteries that play a compensatory role in collateral circulation and are an important feature of the disease. The incidence of moyamoya disease is high in East Asian countries, and there is certain family clustering. Genetic factors may participate in the onset of moyamoya disease. It is more common in women, and there are two peak onset ages in children and young adults. Cerebral ischemia and intracranial hemorrhage are the two main hazards of the disease. Generally, cerebral ischemia is the main cause in children and adults, while intracranial hemorrhage is more common in adults^{[2,3,4,5,6,7,8,9,10]}。 In recent years, the incidence and prevalence of moyamoya disease in China have gradually increased, but there are still many controversies in the diagnosis and treatment, especially the differentiation between this disease and moyamoya syndrome mainly depends on the exclusion of dozens of concomitant diseases, lack of operability in clinical practice and certain legal risks. In view of this, we jointly discussed and formulated the Chinese expert consensus on the diagnosis and treatment of moyamoya disease and moyamoya syndrome.

Microscopic neurosurgery began in the early 1960s. The application of microscopic technology has greatly improved the curative effect of neurosurgery, and the surgical trauma is greatly reduced compared with open-eyed surgery. Therefore, microscopic surgery has been widely used and has become a basic technology of neurosurgery. Over the past 50 years, with the accumulation of experience in microsurgery, the improvement of microscopic technology, the improvement of microscopic instruments and the advancement of neuroimaging technology, it is possible and necessary to further minimally invasive microsurgery, thus the emergence of keyhole microneurosurgery technology. Therefore, keyhole neurosurgery is the product of the combination of modern microsurgery technology, neuroimaging technology, neuroendoscopy technology and modern minimally invasive surgery concept, and it is one of the representative technologies of microsurgery towards minimally invasive neurosurgery.

deep brain stimulation (DBS) has become an effective treatment for central dyskinesia because of its minimally invasive, adjustable and reversible nature. Bleeding, infection, skin ulceration and program-controlled adverse reactions have been reported in the literature^[1,2,3]。 However, there are few related literatures on peri-electrode edema (PEE) after DBS^[4,5]。 At present, the description and understanding of PEE after DBS are not consistent^[6,7]The possible causes and mechanisms of triggering are also unclear. A total of 90 patients underwent DBS in the Department of Neurosurgery, Xinjiang Military Region General Hospital from May 2008 to May 2015. This study conducted a retrospective analysis of postoperative imaging showing PEE, which is reported as follows.

cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease. In 1946, Ecker first described that blunt craniocerebral trauma can cause sigmoid sinus thrombosis. Since then, only a few cases of CVST have been reported, and clinicians know little about the clinical characteristics, treatment and prognosis of the disease. From March 2013 to March 2016, five children with lateral sinus thrombosis after closed craniocerebral trauma were admitted to the Department of Neurosurgery of Shanxi Children's Hospital. Now, their clinical manifestations, imaging manifestations, treatment methods and prognosis are discussed in combination with literature reports.

In 1988, vagus nerve stimulation (VNS) was first applied in clinical treatment of drug-refractory epilepsy. VNS is an intermittent vagus nerve stimulation by placing a nerve control assist system to achieve the therapeutic purpose. As a new technology, VNS has been paid more and more attention by neurosurgeons at home and abroad for its unique safety, long-term efficacy and tolerability^[1,2]。 Typically, vague nerve stimulation system (VNSS) implantation uses double incisions, with one incision located in the neck for placement of electrodes; The other is located below the collarbone or before the axilla and is used to place the pulse generator. It has been reported abroad that VNSS was implanted with a single incision in the neck, and its efficacy was satisfactory^[3]。 Therefore, considering the concept of minimally invasive surgery, this article draws on and improves the surgical technique, and adopts a single incision in the neck combined with microsurgery to implant VNSS, with satisfactory results, which are presented as follows.

Case 1 male, 78 years old. The main cause of right roof mass was admitted for 2 months. Physical examination showed a round-like mass with a diameter of about 3 cm on the top of the right skin, which was hard, reddish and movable. Local hair loss, hair follicles, sweat gland openings can be seen. The pupils on both sides are large and equally round, and they are sensitive to light reflection. Physical movement is normal. Chest CT showed left lung cancer and bronchitis (Figure 1)。 Lung cancer of the lower lobe of the left lung, bronchitis, was diagnosed. The scalp mass was resected. The tumor was located in the soft tissue under the scalp, and the boundary with the scalp tissue was clear. Pathological findings suggest that subscalp moderately differentiated squamous cell carcinoma (Figure 1)。

moyamoya disease (MMD) is a common disease in neurosurgery. When MMD occurs clinically, even patients with intracranial blood supply in compensatory balance and no clinical symptoms are prone to cerebral ischemia or cerebral hemorrhage. Studies have found that cerebral hemorrhage in patients with MMD is mostly caused by rupture of intracranial aneurysm combined with MMD, and such cases were reported as early as 1973^[1]。 The classification of MMD with intracranial aneurysm is not only complicated, but surgical treatment and surgical anesthesia can also disrupt the compensatory balance of intracranial blood supply, which makes there is no unified scheme to standardize the treatment of MMD^[2,3,4,5,6]。 Therefore, this article reviews the related literature of MMD complicated with intracranial aneurysm and reviews its treatment status, aiming to improve the understanding of rational treatment of MMD complicated with intracranial aneurysm.

tardive dystonia (TD) is a dyskinesia caused by patients taking dopamine receptor antagonists. Its symptoms are persistent and irreversible, which seriously affects the quality of life of patients and may even cause disability. At present, drugs are mostly used to treat this disease, but the long-term efficacy of drugs is not ideal, and the adverse reactions are large and there is a risk of further aggravation of dystonia. At present, studies at home and abroad have pointed out that stereotactic surgery can obtain long-term and stable curative effect. This surgery can significantly improve the motor function and quality of life of patients with TD, and at the same time, it is also beneficial to improve the mental symptoms of patients. Therefore, stereotactic surgery may be a better treatment option for TD.