2018年 · 第34卷第01期

After 13 years, the fourth edition of "WHO Endocrine Tumor Classification" was published in June 2017, and the pituitary tumor classification finally ushered in an update^[1]。 From a clinical point of view, the biggest changes of the new version include: (1) The classification of pituitary adenomas according to the different hormones secreted by tumor cells has been changed to classifying them according to adenopituitary cell lineages, highlighting the role of lineage-specific transcription factors that regulate pituitary cell differentiation (Table 1)； (2) The controversial classification of "atypical pituitary adenoma" was eliminated; (3) More description of pituitary non-neuroendocrine tumors was made, and many new classifications were introduced. This article will mainly interpret the 2017 version of WHO pituitary tumor classification for the above three changes in the new version.

Medical-related ventriculitis and meningitis are common complications of neurosurgery, which seriously affect the prognosis and outcome of patients. Although most patients have an acute onset during hospitalization, a few still develop delayed infection even years after discharge. To date, the results of neurological and surgical treatments for medical-related ventriculitis and meningitis have not been satisfactory^[1]。 In order to solve many problems in clinical diagnosis and treatment, the Infectious Diseases Society of America (IDSA) issued the 2017 IDSA Guidelines for the Treatment of Medically Related Ventriculitis and Meningitis (hereinafter referred to as the Guidelines) in 2017^[2]。 The Guidelines are based on evidence-based medicine and involve the diagnosis, treatment and prevention of medical-related ventriculitis and meningitis, which has important guiding significance for improving the diagnosis and treatment level. Combined with the relevant literature recently published in China, the following is interpreted for the reference of medical staff.

Infant spastic hemiplegia is often accompanied by drug-refractory epilepsy, and imaging usually shows extensive atrophy and softening of one cerebral hemisphere^[1]。 Hemispherectomy is the most effective treatment^[2,3]。 Traditional anatomical hemispherectomy has been replaced by functional hemispherectomy due to severe long-term complications and high incidence. Cerebral hemispherectomy is a functional hemispherectomy with minimal excision of brain tissue^[4,5]。 From August 2014 to January 2016, the Department of Neurosurgery, General Hospital of Ningxia Medical University used periinsular hemispheric dissection to treat 4 infants with hemiplegia with refractory epilepsy, and the curative effect was satisfactory. The literature is summarized as follows.

Massive cerebral infarction usually refers to a complete stroke of the main internal carotid artery, the main middle cerebral artery, or the cortical branch. Cerebral infarction accounts for 60% ~80% of stroke in China, which is an important cause of disability and death^[1]。 Massive cerebral infarction is a kind of serious cerebral infarction, with an incidence of 10~20/100,000^[2], accounting for about 10% of cerebral infarction. It has acute onset and rapid progression, and high disability rate and mortality rate. From January 2011 to June 2015, 116 patients with massive cerebral infarction were treated in the Department of Neurosurgery, Teaching Hospital of Putian First Hospital of Fujian Medical University, accounting for 12.5% (116/928) of the patients with cerebral infarction treated in our hospital in the same period, including 19 cases in the conservative treatment group and 97 cases in the modified decompressive craniectomy group. The retrospective analysis is as follows.

Meningioma mainly originates from cap cells of arachnoid, accounting for about 15% ~20% of primary intracranial tumors. It is one of the common intracranial tumors, but meningiomas outside the central nervous system are rare. Due to the lack of characteristic symptoms and signs, it is prone to clinical misdiagnosis. A patient with extracranial temporal fossa meningioma was admitted to the Department of Neurosurgery, Brain Hospital affiliated to Nanjing Medical University in April 2016. Combined with the relevant literature in recent years, it is summarized and reported as follows.

Subarachnoid hemorrhage caused by intracranial tumors is rare, and hemorrhage from brain tumors accounts for 1% ~11% of cerebral hemorrhage^[1]。 Vestibular schwannoma accounts for 5% ~8% of intracranial tumors^[1]Most of the hemorrhage is intratumoral hemorrhage, and cases of subarachnoid hemorrhage are rare. So far, more than 10 cases have been reported in the literature. The reports of spontaneous hemorrhage of vestibular schwannoma into the fourth ventricle and subarachnoid hemorrhage are more rare. In May 2016, a patient with vestibular schwannoma bleeding and rupture into the subarachnoid space and ventricles was admitted to the Department of Neurotumor Surgery of the First Hospital of Jilin University. The report is as follows.

The local anatomy involved in neurosurgery is complex, and the amount of data information provided by single modal imaging is small, which cannot meet the clinical needs. In recent years, medical 3D image fusion technology has developed rapidly, and combined with neuronavigation and intraoperative imaging, it has been gradually applied to many neurosurgical fields such as cerebrovascular disease, brain tumor, epilepsy surgery, spinal vascular malformation, trigeminal neuralgia and hemifacial spasm^{[1,2,3,4,5,6,7,8,9,10]}。

In the central nervous system, glial cells account for about 90% of the total number of cells, and astrocytes are its main component. For a long time, it has been believed that the main functions of the central nervous system are performed by neurons, while astrocytes only play the functions of supporting, nourishing and metabolizing neurons. In recent years, it has been found that astrocytes also play an important role in maintaining normal brain function^[1,2]In addition, it can affect the occurrence and development of some diseases, such as cerebrovascular disease, astrocytoma, epilepsy^[3]Alexander's disease^[4]and neurodegenerative diseases^[5,6]Etc. Therefore, the study of astrocytes is of great significance for understanding the pathogenesis of related diseases. However, astrocytes are easily contaminated by other cells in primary culture, which limits their application in the research field. Human pluripotent stem cells can differentiate into multiple types of somatic cells while retaining the ability to renew themselves^[7,8,9]。 In recent years, the study of induced differentiation of pluripotent stem cells into astrocytes has made great progress. In this paper, the research progress of experimental methods of inducing pluripotent stem cells to differentiate into astrocytes is reviewed.

According to the 2012 China Cancer Registry Annual Report, intracranial and central nervous system malignant tumors accounted for 2.25% of systemic malignant tumors, and the standardized incidence rate of China's population was 4.11/100,000. Among them, the incidence of high-grade gliomas (HGG) is 5~8/1 million^[1]。 At present, the treatment of glioma is limited, and a large number of glioma clinical trials have been carried out in order to find effective new treatment methods for glioma. How to accurately judge the effect of various new treatments is the key link in all clinical trials. overall survival (OS) is the gold standard of various clinical trials, but its application also has certain limitations: First, clinical trials with long observation periods, such as low-grade gliomas (LGG) with long survival periods, if OS is the end point, a lot of manpower, material resources and financial resources are needed to complete; Second, various rescue treatments after tumor recurrence may have a biased effect on clinical treatment results^[2]。 progression-free survival (PFS) and radiographic response rates (RR) may more accurately reflect the true effects of new therapies, and are often the endpoints of clinical trials of neurotumors^[3,4]。 Accurate assessment of tumor response to treatment, effective distinction between effective response and false response, correct differentiation between true recurrence and false progression, and early detection of disease progression are all crucial to judge PFS and RR. It is necessary to establish a set of objective and standardized evaluation criteria for neurotumor efficacy to meet the above requirements.

Gliomas are the most common intracranial tumors, accounting for about 80% of intracranial malignant brain tumors^[1]glioblastoma multiform (GBM) has the highest malignancy. In recent years, despite the continuous progress of surgical treatment, radiotherapy, chemotherapy and targeted therapy, and the comprehensive and individualized treatment plan, the treatment effect and prognosis are still poor. The average survival time of GBM patients after surgery, radiotherapy and chemotherapy is only 18 months^[2]5-year survival rate is less than 10%^[3]。 Therefore, it is very important to actively explore the pathogenesis of glioma and find new treatment methods. The safety and efficacy of ketogenic diets (KD) as a new method for the treatment of glioma^[4]。 This article will summarize the current research status of KD therapy in the treatment of glioma.

In recent years, more and more studies have been made at home and abroad on the etiology, pathogenesis, treatment and complications of hemifacial spasm (HFS), and great progress has been made. However, there are few studies on the recovery time limit and countermeasures of facial paralysis after HFS operation, and the time boundary for clinical intervention of postoperative facial paralysis (including facial paralysis caused by facial nerve injury and facial paralysis with delayed appearance after operation) is still unclear. This article searched eight databases, including PubMed, MedLine, Web of Science, Embase, CNKI, Wanfang, VIP and SinoMed, to collect the current research on facial paralysis after HFS surgery at home and abroad, and reviewed the research progress of recovery time and countermeasures of facial paralysis after HFS microvascular decompression (MVD).