2017年 · 第33卷第11期

The diagnosis and treatment of craniopharyngioma is one of the major challenges facing neurosurgery. Because the tumor is deep and the adjacent structure is complex and important, surgery or radiotherapy may cause serious damage to important structures such as optic chiasm and hypothalamus, so the clinical treatment of this disease is often difficult, dangerous and heavy^[1,2]。 In addition to surgical techniques, the diagnosis and treatment of craniopharyngioma also tests the neurosurgeon's comprehensive technical ability in preoperative evaluation, postoperative management and long-term complication management. In the past few decades, the comprehensive treatment level of craniopharyngioma, such as surgical treatment, radiotherapy and drug treatment, has made great progress, and the treatment effect has been greatly improved^[3,4,5]。 However, the recurrence rate and complication rate of tumor are still very high, which seriously affects the quality of life of patients. There are still many technical difficulties and theoretical problems that need in-depth research and innovative tackling to solve this problem. At the same time, with the rapid development of modern science and technology, new theories, new technologies and new methods are constantly emerging, which provides a good opportunity for the improvement of the basic and clinical research level of craniopharyngioma. Efforts to strengthen the research in this field will further promote the comprehensive research and clinical diagnosis and treatment level of craniopharyngioma.

deep brain stimulation (DBS) is an effective surgical treatment for Parkinson's disease (PD)^[1,2,3]。 Clinical studies have shown that domestic DBS stimulator can significantly improve the exercise (Ⅲ) score and daily living ability (Ⅳ) score of the unified parkinson's disease rating scale (UPDRS) in the "on" and "off" periods of PD patients, and prolong the "on" period^[4,5]。 Common targets of DBS in the treatment of PD include subthalamic nucleus (STN) and globus pallidus internus (GPi). At present, STN is mostly used in China. Although STN-DBS can significantly improve the symptoms of tremor and stiffness in PD patients, there are still some limitations on the improvement of dyskinetic symptoms. Therefore, this study used domestic DBS stimulator and GPi as the target to treat PD patients with dysmotor symptoms, and achieved good efficacy, which is reported as follows.

deep brain stimulation (DBS) has become a well-recognized neurosurgical treatment for Parkinson's disease, dystonia, essential tremor and other intractable movement disorders^[1,2,3]。 With the entry of DBS into China's medical market and the clinical launch of domestic DBS systems, the number of domestic patients receiving this therapy continues to grow^[4]。 There are many manufacturers and various product models of DBS nerve stimulators, namely implanted pulse generators (IPGs), currently on the market. Clinically, when imported IPGs are replaced with domestic models or domestic IPGs are replaced with new models, because the DBS extension leads of different manufacturers and the extension leads of the old models are not suitable for the newly implanted IPG connection ends, it is usually necessary to replace them with new extension leads. Improper operation may lead to hardware-related complications such as damage to the original implanted electrode, slipping of the extension lead, or bowstring phenomenon^[5,6]。 From April 2014 to August 2017, the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, replaced extension leads simultaneously in 22 patients who underwent domestic DBS IPG replacement surgery. Special lead electrode connection end protection and fixation methods and extension lead tunnel preparation methods were adopted. No complications related to surgical operation occurred in any case, which are reported as follows.

hemangioblastoma (HB) is a benign vascular tumor composed of dense vascular plexus and tumor stromal cells, accounting for 2% of intracranial tumors and 10% of posterior fossa tumors. Clinically, it can be divided into sporadic HB and familial HB with genetic background^[1]。 Familial HB patients are associated with retinal hemangioma, renal cyst, pancreatic cyst, etc., which is called VHL (Von Hippel-Lindau, VHL) disease, and is closely related to VHL gene mutation^[2]。 Five patients with HB in the same family were treated in the Department of Neurosurgery, Affiliated Cancer Hospital of Zhengzhou University from July 1990 to April 2016. The reports are as follows.

Puncture and drainage of intracranial hematoma has been widely used in clinical practice because it avoids further damage caused by incision, pulling and electrocautery of brain tissue. Since 2003, the neurosurgery department of Ganzhou Municipal Hospital has performed intracranial hematoma puncture and drainage by using brain CT patch to locate the best puncture point through CT scan, and achieved good therapeutic effect^[1]。 However, there are still some defects in the operation, such as the difficulty to grasp the puncture direction and angle after disinfection and towel spreading. Therefore, from January 2013 to November 2015, our hospital developed a brain puncture auxiliary frame on the basis of brain CT positioning patch, and performed intracranial hematoma puncture and drainage in 38 patients with intracranial hemorrhage with brain puncture auxiliary frame and brain CT positioning patch, and the curative effect was satisfactory, which is reported as follows.

hemangioblastoma (HB) is a benign tumor that occurs mostly in the cerebellum^[1]。 Von Hippel-Lindau disease (VHL) is a rare autosomal dominant genetic disorder involving multiple systems. Familial HB is the most common characteristic manifestation of VHL, which is mainly manifested as HB involving cerebellum, spinal cord, kidney, spleen and retina^[2,3]。 In February 2017, the Department of Neurosurgery, Fuxing Hospital affiliated to Capital Medical University admitted a patient with recurrent familial HB to explore the mechanism, clinical characteristics, diagnosis and treatment methods of the disease.

Neurocutaneous melanosis, first reported by Professor Von Rokitanski in 1861, is a rare neurocutaneous syndrome with little difference in male to female ratios. Is a genetic disease caused by dysplasia of the embryonic neuroectoderm, characterized by large or multiple congenital melanocytic nevus and a large number of melanomas in the central nervous system^[1]。 Patients usually have skin melanotic nevus at birth, and then neurological symptoms such as epileptic seizures, intracranial hypertension, mental retardation, cranial and spinal nerve damage, etc. The disease progresses with gait disorders, and then loses the ability to walk. Most symptoms appear before the age of 2^[2]。 This article reports a child with neurocutaneous melanosis accompanied by temporal lobe epilepsy admitted to the Epilepsy Center of Yuquan Hospital of Tsinghua University in April 2016.

Plasma cell tumors are clonal plasma cell proliferation. Intracranial plasma cell tumors refer to plasma cell tumors that invade the skull, meninges and brain^[1]。 A patient with solitary myeloplasmacytoma of the skull was admitted to the Department of Neurosurgery of Huaihe Hospital of Henan University in January 2014. The report is as follows.

Maltese brucellosis is a zoonotic infectious allergic disease caused by Brucella infection. The main source of infection is sick animals and carrier animals. The disease spreads through the digestive tract, or through skin and mucous membrane contact, respiratory tract and other routes, and infects the human body can involve all systems in the whole body^[1,2]。 At present, brucellosis with intraspinal infectious granuloma as the main clinical manifestation is rarely reported at home and abroad. This article reports a case of Maltese Brucella intraspinal infectious granuloma, which provides a basis for clinical diagnosis and treatment.

Craniopharyngioma accounts for about 2% ~5% of primary intracranial tumors and 5.6% ~15% of children's intracranial tumors^[1]The annual population incidence rate is 1.3 per 1 million. Although the histological manifestations are benign tumors, the quality of life is often seriously affected by the damage of important structures such as optic nerve, hypothalamus and pituitary gland. Because of the deep location of the tumor and the complex and important adjacent structure, surgical treatment is extremely challenging^[2], resulting in low total resection rate, high recurrence rate and complication rate, low quality of life of patients, and its clinical efficacy still needs to be further improved. This article reviews the pathological classification, clinical classification and treatment modalities of craniopharyngioma.

spinal dural arteriovenous fistula (SDAVF) is an extremely rare disease, with an annual incidence rate of about 5~10/1 million^[1]The incidence of middle-aged and elderly men is high, with a male-female ratio of about 4: 1^[2]； It is the most common type of spinal vascular malformations, accounting for about 80%^[3,4]。 McCutcheon et al.^[5]Studies have confirmed that SDAVF is the direct communication between the arteries of the dura and the drainage vein. The drainage vein transmits pressure from the blood supply artery to the coronary venous plexus of the spinal cord, resulting in spinal venous hypertension, congestion and edema of the spinal cord tissue and spinal cord dysfunction^[6,7,8]。 In the early stage, SDAVF patients mainly showed sensory and motor abnormalities of both lower limbs. With the development of the disease, they were often accompanied by defecation and urination disorders, and male patients also had sexual dysfunction^[3]。 Due to the lack of specificity of the above symptoms, the early diagnosis of SDAVF is difficult, and it is often easily confused with spinal degenerative diseases, spinal cord tumors, myelitis, subacute combined degeneration of spinal cord and other diseases, resulting in misdiagnosis and missed diagnosis^[9,10,11]。 At present, with the popularization of spinal cord MRI and angiography, the diagnosis rate of SDAVF has improved significantly, and two mature treatment methods, microsurgery and endovascular embolization, have gradually formed. However, most patients have obvious spinal cord function before treatment. Damage, its prognosis is not ideal. A meta-analysis of the prognosis of patients with SDAVF showed that the symptom improvement rate of patients with SDAVF after surgery was only 55%, and the improvement rate of defecation and urinary function was only 38%^[12]。 In recent years, more and more scholars have begun to pay attention to the related factors affecting the prognosis of patients with SDAVF. This article summarizes the related studies on the prognostic factors of SDAVF patients in recent years as follows.

Primary hemifacial spasm (HFS) occurs more often than in adulthood, and is more common in unilateral onset. It is mainly manifested as paroxysmal involuntary twitching of the facial muscle, and the course of the disease is prolonged. Sometimes it can lead to smaller palpebral fissure and skewed mouth corners, which seriously affects the quality of life of patients. Because of the large population base in China, the incidence rate of this disease is about 18.6/100,000 population, and the number of patients is huge, so the diagnosis and treatment of primary HFS is of great significance.