2017年 · 第33卷第12期

Although pediatric neurosurgery in China has made great progress in the past two decades^[1]However, with the development of medical science, especially in the field of neuroscience, the development of traditional single-discipline treatment models has been unable to meet the needs of patients. The mode of multi-discipline combination is the general trend of discipline construction in the medical field^[2]。 When a child needs brain surgery, the parents of the child are concerned about whether the lesion can be totally removed, whether the surgery has any impact on limb function and intelligence, whether the body can develop normally, whether it affects marriage or procreation, etc. The above questions are definitely not answered and solved by a single subject of pediatric neurosurgery, which involves pediatrics, pediatric surgery, oncology, endocrinology, neuroelectrophysiology, neuroimaging, brain cognitive function, radiotherapy, chemotherapy, mental health (psychology), rehabilitation medicine, materials science (non-metal implants) and other multidisciplinary systems. These disciplines are complex spider network relationships rather than relationships of parallel lines. This requires a pediatric neurosurgeon not only to master the knowledge and skills of this discipline, but also to understand the disciplines that have a supporting role and influence on pediatric neurosurgery, and to apply them reasonably in clinical medicine.

Lumbar degenerative spinal stenosis refers to the stenosis of the lumbar spinal canal, nerve root canal and intervertebral foramen caused by degenerative causes. This disease is often accompanied by lumbar disc herniation, vertebral hyperplasia, hyperplasia, hypertrophy, calcification or ossification of posterior longitudinal ligament and ligamentum flavum, hypertrophy of synovial sac of facet joints, spondylolisthesis and other pathological changes. Spinal stenosis may entrap and stimulate the spinal cord, nerves and blood vessels, thus causing corresponding clinical symptoms, such as lumbar and leg pain. In severe cases, weakness of both lower limbs, sphincter relaxation, defecation and defecation disorders, etc. may occur, which is called lumbar spinal stenosis. Lumbar spinal stenosis is divided into central stenosis, lateral recess stenosis and nerve root foramen stenosis according to anatomical site.

brain arteriovenous malformation (bAVM) is a congenital disease with an annual incidence rate of 1.12~1.42/100,000 people^[1,2,3,4]。 Cerebral hemorrhage is the most common clinical manifestation of bAVM, with an annual hemorrhage rate of about 2.10% to 4.12%, and about 36% to 68% of patients bleed at the first visit. The risk of rebleeding after initial cerebral hemorrhage increased, from about 9.65% to 15.42% in the first year, and then decreased year by year, and from 1.70% to 3.67% after 5 years^[5,6]。 The annual disability and fatality rates after bAVM hemorrhage were approximately 1.7% and 1.0%, respectively^[7]。 Given the high rebleeding rate of ruptured bAVM, it has been widely recognized that ruptured bAVM needs aggressive treatment, while whether unruptured bAVM needs treatment and the choice of treatment mode are still controversial.

neural tube defects (NTDs) have been considered to be diseases caused by the interaction of genes and the environment. A number of environmental factors have been found to be associated with the pathogenesis of NTDs, especially folic acid deficiency. However, in genetic research, little progress has been made. Whole exon sequencing, as an emerging high-throughput, high-efficiency and relatively low-cost sequencing technology, provides an opportunity for the study of genetic causal factors of various diseases. Exons are the regions where most of the phenotype-related functional variations occur, but their number only accounts for 1% of the total length of the whole genome. The whole exon sequencing method is used to enrich the whole human exon region for sequencing, and to study various variations in disease-related regions, especially single nucleotide polymorphism (SNP), insertion and deletion, with high specificity, high accuracy and timeliness^[1]。 In order to investigate the genetic factors related to the pathogenesis of NTDs in Chinese population, the whole exon deep sequencing of peripheral blood DNA of 16 children with severe NTDs was performed in this study, and further bioinformatics analysis was performed to discover new pathogenic genes.

Epidural hematoma refers to the hematoma formed in the space between the epidural mater and the skull mainly caused by hemorrhage of the dural artery and vein, venous sinus or skull plate barrier^[1]。 Because the dura mater is closely attached to the inner plate of the skull, cases of epidural hematoma in infants and young children are relatively rare^[2]。 From August 2011 to April 2013, 3 infants with epidural hematoma complicated with scalp hematoma and skull fracture were treated in the Department of Neurosurgery of Hebei Children's Hospital. The scalp hematoma puncture resulted in good results, which are reported as follows.

Hypertensive cerebral hemorrhage is a spontaneous cerebrovascular disease caused by the rupture and hemorrhage of small blood vessels in the brain caused by acute increase of blood pressure. It has the characteristics of rapid onset, high morbidity, disability and mortality^[1]It is more common in patients over 50 years old with long-term essential hypertension and atherosclerosis. In recent years, the onset of the disease has become younger. According to the Guidelines for the Diagnosis and Treatment of Spontaneous Intracerebral Hemorrhage in Adults issued by the American Heart Association and the Stroke Association in 2015, craniotomy for hematoma evacuation may be considered for supratentorial lobar hematoma>30 ml and less than 1 cm from the brain surface^[2]But there is no clear diagnosis and treatment guidance for cerebral hemorrhage in the basal ganglia region. Kanaya and Kuroda^[3]The retrospective study found that patients with supratentorial hematoma volume>30 ml and consciousness level between lethargy and light coma can be treated surgically; In patients with intracerebral hematoma>50 ml, surgery cannot change the quality of life of patients compared with conservative treatment. At the same time, Zhao Jizong et al^[4]Preoperative Glasgow Coma Scale (GCS) was reported<In patients with cerebral hemorrhage with 8 scores, the mortality rate at 3 months after surgery was 3.5 times that of patients with GCS ≥8 scores. Therefore, this study retrospectively included 49 patients with hypertensive cerebral hemorrhage with bleeding volume of 30-40 ml and GCS ≥8 scores admitted to the Department of Neurosurgery of the First Affiliated Hospital of Dalian Medical University from January 2013 to June 2015, of whom 23 patients were treated with craniotomy and hematoma evacuation (surgical group) and 26 patients were treated with conservative treatment (conservative group). By comparing the clinical efficacy of the two groups, we hope to provide a reference for the choice of treatment mode for patients with hypertensive cerebral hemorrhage.

Lateral ventriculocentesis is an effective method for the treatment of hydrocephalus and ventricular hemorrhage, which can quickly reduce intracranial hypertension, improve clinical symptoms of patients and promote neurological recovery. However, the conventional method of transfrontal lateral ventricle puncture often has deviations, resulting in the puncture failure to enter the ventricle, resulting in unsuccessful puncture. Therefore, in this study, the coronal plane of transfrontal lateral ventricle puncture was reconstructed in three dimensions after CT imaging of the head, and the angle and depth of puncture were measured on this plane to guide the actual puncture process and improve the accuracy of puncture.

Clinically, spinal cord and spinal lesions often cause corresponding neurological dysfunction. Patients mostly see a doctor for limb sensory or motor disorders, and the diagnosis is easy to confirm by neurological physical examination and imaging findings. However, very few patients with spinal spinal lesions can be complicated by Charcot arthropathy, with joint destruction, which is easily confused with diseases such as primary arthritis. From September 2010 to September 2015, the Department of Neurosurgery of Ganzhou People's Hospital treated two patients with spinal cord disease complicated by Charcott's arthropathy and were misdiagnosed for a long time. After diagnosis and treatment, they improved. The report is as follows.

Subdural effusion is a common disease in pediatric neurosurgery, especially in traumatic craniocerebral injury and intracranial infection. Subdural-peritoneal shunt is the most commonly used surgical procedure for subdural effusion in children^[1,2]Similar to ventriculo-peritoneal shunt, many complications occur in the treatment of subdural effusion or hydrocephalus, with the incidence of intra-abdominal complications ranging from 5% to 30%^[3,4]。 However, the abdominal end of the shunt is displaced into the intestine and prolapsed out of the anus with the intestinal movement is very rare, and its incidence rate<0.1%^[5]。 With the popularization of laparoscopic technology, the surgical procedure assisted by gel laparoscopy is also used in patients with peritoneal shunt and postoperative complications. In November 2015, the Department of Neurosurgery, the Second Affiliated Hospital of Wenzhou Medical University admitted a patient with laparoscopic treatment of children's subdural effusion-peritoneal shunt after shunt displacement into the intestinal canal and transanal prolapse, which is now reported in the literature as follows.

primitive neuroectodermal tumor (PNET) is a rare malignant tumor composed of undifferentiated neuroectodermal cells with the ability to differentiate in multiple directions^[1]。 The clinical incidence is low and can be divided into central and peripheral types according to the origin of tumor cells^[2]。 Peripheral PNET can occur in bone, soft tissue, retroperitoneum, and pleura. The invasion of peripheral PNET into the spinal canal is rare in children. This paper reports a case of posterior mediastinal PNET invading the surrounding tissues and invading the spinal canal causing nerve compression in a child.

The pituitary gland is located in the sella turcica and is divided into adenopituitary gland (anterior lobe) and neuropituitary gland (posterior lobe). The adenopituitary gland differentiates from the Rathke sac of the ectoderm, while the neuropituitary gland is derived from the neuroectoderm at the base of the forebrain. The anterior pituitary gland synthesizes and secretes six hormones: adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin (PRL), thyrotropic hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones act on their respective target glands, regulate the synthesis and secretion of related downstream hormones, thereby controlling the self-stabilization of metabolism, growth and reproduction functions of the body^[1,2]。 The anterior pituitary gland itself is regulated by a variety of factors, including hypothalamus, pituitary cells themselves and negative feedback factors of peripheral target glands. These 3 factors control the life cycle of pituitary cells and the synthesis and secretion of pituitary hormones. Therefore, the occurrence of pituitary adenoma is the result of the combination of three mechanisms: hypothalamus, pituitary cells themselves and negative feedback factors of peripheral target glands.

With the development of interventional materials and imaging techniques, the proportion of patients with intracranial aneurysms undergoing endovascular treatment is increasing year by year. However, complex intracranial aneurysms such as large, wide-necked, fusiform aneurysms are still difficult to achieve complete closure by coil embolization. In recent years, flow diverter (FD) has provided a new way of thinking to solve this problem. The FD is a self-expanding, braided, highly deformable mesh stent with low porosity and high metal coverage. Its mechanism of action is to provide resistance at the neck of the tumor, reduce the blood flow into the intracranial aneurysm, and smoothly merge it into the outflow tract of the tumor-bearing artery, creating a hemodynamic environment conducive to intratumoral thrombosis. Hemodynamics plays an important role in the occurrence, development and rupture of intracranial aneurysms. computational fluid dynamics (CFD) can simulate the best FD placement strategy and evaluate the prognosis of patients before surgery, and provide personalized guidance for the treatment of intracranial aneurysms^[1]。 The research progress of CFD in FD treatment of intracranial aneurysms is summarized as follows.

With the further development of biomedicine, people's understanding of stem cells is getting deeper and deeper. Stem cells are a kind of cells with the characteristics of self-replication, renewal and induction of differentiation. They can transform into a variety of highly differentiated cells in the body, and play an important role in tissue repair, regeneration and replenishment of missing tissues in the body. At present, stem cells have received extensive attention in biomedical research, and their clinical application has been gradually deepened. Masjkur et al.^[1]It was found that stimulating stem cells in the body through nerve and vascular signals can induce blood vessel formation and promote damaged tissue repair. 2016 Bang et al.^[2]Treatment of stroke with mesenchymal stem cells and bone marrow-derived mononuclear cells resulted in improved symptoms. These studies indicate that stem cells have great application prospects in nerve regeneration and tissue repair.