2017年 · 第33卷第09期

microvascular decompression (MVD) of cerebellopontine angle (CPA) is currently the most effective method to completely cure trigeminal neuralgia (TN), glossopharyngeal neuralgia (GN) and hemifacial spasm (HFS). Because of the complex anatomical structure and important neurological function of CPA, redundant or inappropriate operation can easily cause accessory damage to related cranial nerves, cerebellum and brainstem. On the premise of preserving the normal neurological function of patients, whether the responsible blood vessels can be accurately decompressed is largely related to the skills and experience of the surgeon. The application of intraoperative neurophysiological monitoring (IONM) in MVD is beneficial to the protection of intraoperative nerve function and the evaluation of curative effect. At present, with the popularization and application of IONM, the application research level of Chinese scholars in this field is gradually in line with the international standards. How to interpret the significance of IONM signal changes objectively is always worth the attention of the surgical team, and the application mode and value of IONM technology in MVD are also worth further discussion.

Stroke is one of the main diseases that cause human death and disability. Epidemiological survey shows that in 2013, the annual standardized prevalence, morbidity and mortality of stroke in China were 1,114.8/100,000, 246.8/100,000 and 114.8/100,000, respectively^[1]； While the incidence and mortality of stroke in European and American countries are gradually decreasing, the incidence of stroke in China is increasing at a rate of 8.7% per year, which is significantly higher than the overall annual incidence of stroke in the world^[2]。 At present, stroke has become the first cause of death among our nationals. Among new onset patients, ischemic stroke accounted for 70% of the total^[3]The treatment level of acute ischemic stroke (AIS) is related to the health of Chinese residents.

Microvascular decompression is a classic method for treating trigeminal neuralgia, but it is easy to relapse after operation, with a recurrence rate of 3.0% ~30.0% and an annual recurrence rate of 2.0% ~3.5%. The vast majority of patients relapsed within 2 years after microvascular decompression, and fewer patients relapsed more than 5 years after surgery^[1]。 There are different reports at home and abroad on the causes of postoperative recurrence and the choice of treatment^[2,3,4]However, most of the selected subjects were those with recurrence within 2 years after surgery, and there were few reports of recurrence more than 5 years after surgery. From January 2004 to December 2009, 312 patients with trigeminal neuralgia were treated by microvascular decompression in the Department of Neurosurgery of Wuxi Second Hospital affiliated to Nanjing Medical University. They were followed up for 5 to 10 years for a long time. The clinical data of 11 patients with trigeminal neuralgia who relapsed more than 5 years after operation were analyzed, and the causes and treatment methods of their relapse were discussed.

Pituitary adenomas are the most common space-occupying lesions in the sellar region, accounting for 10% to 15% of intracranial tumors^[1]。 Transnasosphenoidal approach surgery has become the main treatment for pituitary adenomas. Diabetes insipidus is a common complication after pituitary adenoma resection through nasosphenoidal approach, with an incidence of 1% to 67%^[2]。 Uncontrolled diabetes insipidus will lead to hypernatremia and plasma hyperosmolarity, which can lead to dehydration, lethargy, mental abnormalities, and seizures in severe cases. The influencing factors of postoperative diabetes insipidus are still controversial. Understanding the factors associated with diabetes insipidus after pituitary adenoma surgery will help improve perioperative management. This study retrospectively analyzed the clinical data of 65 patients with pituitary adenoma admitted to the Department of Neurosurgery of Fuzhou General Hospital from March 2014 to March 2015 to explore the related factors of diabetes insipidus after transnasosphenoidal approach.

Animal experiments and clinical studies at home and abroad have confirmed that the ventrolateral coracal end of the medulla oblongata is the center of cardiovascular regulation, and if it is compressed by vascular pulsation, it can cause increased sympathetic nerve excitability and blood pressure^[1,2,3,4]。 For hypertensive patients with hemifacial spasm and other cranial nerve disorders, microvascular decompression (MVD) was performed at the root exit zoon (REZ) of the ventrolateral coracal end of the medulla oblongata. Postoperative blood pressure decrease has been reported^[5]However, reports of MVD for simple refractory hypertension are rare. This article reports a case of simple neurogenic hypertension treated with MVD in the Department of Neurosurgery of Shengli Oilfield Central Hospital in February 2016, and reviews the relevant literature.

Among scalp tumors, scalp hemangioma, melanoma, neurofibroma, basal cell tumor, squamous cell carcinoma and sarcoma are more common, while large B cell lymphoma is rare^[1]。 Scalp non-Hodgkin's lymphoma (NHL) is often neglected due to mild clinical symptoms, slow progression, no early neurological dysfunction, so the missed diagnosis rate is high. The incidence of primary NHL in the scalp is extremely low, and it is difficult to diagnose only based on imaging findings, and it is easy to be misdiagnosed as osteoma and meningioma. This article retrospectively analyzed the clinical data of a patient with primary scalp giant lymphoma with intracranial invasion admitted to the Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University in June 2016 and conducted a literature review to further improve clinicians' understanding of this disease.

traumatic brain injury (TBI) has become a public health problem worldwide because of its high mortality and disability rate, and refractory intracranial hypertension after TBI is an important cause of poor prognosis and even death. Sedation, intracranial pressure (ICP) monitoring and mild hypothermia therapy are effective ways to monitor and control intracranial hypertension after TBI^[1]。 bispectral index (BIS) is widely used to monitor the depth of anesthesia in surgical patients^[2]。 Some studies have used BIS as a tool to assess the depth of sedation in patients with TBI to guide the use of sedative drugs^[3,4,5]。 The neurosurgical intensive care unit (NICU) of Jiangyin Hospital affiliated to Southeast University School of Medicine treated a patient with intractable intracranial hypertension after TBI in September 2016. After deep sedation, ICP monitoring, mild hypothermia treatment and other measures under BIS monitoring, good results were obtained, which are now reported as follows.

schwannoma (schwannoma) is a benign tumor that originates from the nerve myelin sheath and is one of the most common benign tumors of the nervous system. Schwannoma can occur in cranial nerves and peripheral nerves. At present, the main treatment methods include surgery and stereotactic radiotherapy. Because family hereditary diseases such as neurofibromatosis type 2 (NF2) and schwannomatosis can cause multiple schwannomas, the current treatment methods are not effective^[1]Thus, new treatments are needed. With the deepening of research on the genetics and pathogenesis of schwannoma in recent years, many therapeutic targets have been discovered. At present, a variety of targeted therapeutic drugs have entered the clinical trial stage, providing new treatments for schwannoma. In this paper, the recent research progress in molecular genetics of schwannoma is reviewed.

blood blister-like aneurysm (BBA) originates from the dorsal or anterior wall of the unbranched segment of the internal carotid artery^[1]。 Although cases of BBA located elsewhere in the intracranial circulatory system have been reported in recent years, the classical definition still believes that it originates from the internal carotid artery^[2,3]。 Internal carotid artery BBA is rare in clinic, accounting for 0.9% ~6.5% of internal carotid artery aneurysms, 1.0% of intracranial aneurysms, and 0.5% ~2.0% of all ruptured intracranial aneurysms^[4,5,6]。 Because the cause of formation of internal carotid artery BBA is unknown, the risk of rupture and bleeding is high, and it is difficult to detect by classical imaging methods such as CT angiography (CTA) and digital subtraction angiography (DSA). There is a high false negative rate, and the rate of re-bleeding and recurrence after treatment is high^[1,7]Therefore, its diagnosis and treatment are extremely important. In recent years, due to the improvement of craniotomy and the rapid development of endovascular treatment, there have been some breakthroughs in the treatment of internal carotid artery BBA. This article aims to review the etiology, pathology, clinical characteristics, diagnosis and treatment progress of internal carotid artery BBA.