2018年 · 第34卷第03期

stroke is the leading cause of death and disability in China. At present, the number of cerebrovascular disease patients in China is more than 10 million, and it is increasing at a rate of 8.7% year by year. Among them, acute ischemic stroke (AIS) accounts for about 70% ~80%^[1]。 For patients with AIS with large vessel occlusion (LVO), the severe disability and mortality rate are over 70%, and the standard intravenous thrombolytic therapy is not effective. Six studies published from 2015 to 2016 consistently confirmed the efficacy of AIS-LVO endovascular therapy^{[2,3,4,5,6,7]}, opening a new era of AIS-LVO treatment. The United States, South Korea, Canada, Europe and China have updated their respective AIS treatment guidelines^[8,9,10,11]Endovascular thrombectomy is recommended as the preferred treatment for patients with AIS-LVO. In the United States, a hierarchical stroke center system has been established. In 2016, there were more than 30,000 annual thrombectomies, accounting for about 38.5% of all AIS-LVO patients (the prevalence of AIS-LVO in the United States is about 24/100,000)^[12]。 In contrast, the situation in China is poor. In 2016, only less than 8 000 cases were carried out in China. Considering the large population base in China, the number of AIS-LVO patients may be higher than that in the United States, and its treatment proportion may be smaller. The reasons are, first of all, that stroke patients fail to reach hospitals with treatment ability in time; Secondly, at present, the construction of stroke centers in China is not ideal, and there is a lack of medical institutions that can quickly implement stroke treatment. Therefore, it is of great significance to solve the above problems as soon as possible, so that more and more AIS-LVO patients can get timely and reasonable treatment, which is of great significance to China, which has a heavy burden of stroke.

The prognosis of patients with acute ischemic stroke with large vessel occulsion (AIS-LVO) is extremely poor. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) can only benefit 10% ~20% of patients^[1]。 With the publication of the results of six randomized controlled trials and the expert consensus^[2]It was confirmed that endovascular therapy can significantly improve the clinical prognosis of patients with AIS-LVO with two determining factors: (1) the delay time from onset to reperfusion; (2) Guidance of multimodal imaging for suitable patient selection. Other literatures have further demonstrated and emphasized that the time from onset to reperfusion is closely related to the prognosis of patients^[3,4]。

Before the eighteenth century, wounds were treated primarily on the basis of personal experience; In the late 18th century, the theory of dry healing emerged, and doctors mainly used dry dressing changes to treat wounds^[1]。 Later, during surgical dressing change, it was found that the wound was easy to form crusts and adhere to the dressing during dry dressing change. When the dressing was removed, the patient felt pain, and the wound healed for a long time, which was easy to form infection under crusts^[1,2]。 Studies on wet healing theory began gradually in the 1960s^[3]Wet dressing change can cause wound hypoxia, stimulate capillary growth, increase blood supply, resist infection and promote wound healing^[3,4]。 Since then, wet dressing change has been gradually applied to clinical treatment of wounds.

medulloblastoma (MB) is the most common primary malignant embryonic tumor in the posterior cranial fossa of children, accounting for about 15% ~30% of intracranial tumors in children, and occurs in the cerebellar vermis and the fourth ventricle^[1]。 The peak age of onset is 5 to 7 years old, with more males than females, and less common in adults. According to the 2016 World Health Organization (WHO) pathological classification of central nervous system tumors, MB is divided into five categories: classical type, MB with extensive nodular type, anaplastic type, large cell type, and desmoplastic/nodular medulloblastoma (DMB), all of which are WHO grade IV. Clinically, the classical type of MB is the most common in children, while DMB is less common. From October 2014 to October 2015, two patients with DMB were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University, which are now reported as follows.

desmoplastic fibroma (DF) is also known as aggressive fibroma and desmoid fibroma. According to its onset site, it is divided into intra-abdominal type, abdominal wall type and external abdominal type, among which the external abdominal type is divided into limbs, trunk and head and neck. DF occurring in the skull is extremely rare, and only more than 20 cases have been reported^[1]。 It is reported abroad that it accounts for about 0.3% of benign bone tumors and 0.06% of all bone tumors^[2]There is still a lack of epidemiological data in China. At present, no reports of giant double skull DF have been retrieved. A patient with giant parieto-occipital double skull DF was admitted to the Department of Neurosurgery of Beijing Corps Hospital of the Chinese People's Armed Police Force, which is reported as follows.

arachnoid cysts (AC) are benign intracranial lesions, accounting for 1% of intracranial space-occupying lesions^[1]Generally, it is more common in lateral fissures, followed by the cerebellopontine angle area, tetraassic cistern, and cerebellar vermis. Fewer AC occurred in the sellar region, accounting for 3% of intracranial AC^[2]。 The Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, treated a patient with AC in the sellar area in January 2017, and the report is as follows.

Real-time fluorescence-guided surgery (FGS) refers to the use of specific wavelength excitation light irradiation to stimulate the tumor's own fluorescence, retained fluorescent molecules or exogenous fluorescent substances taken up by cells to emit fluorescence, and guide the surgeon to accurately resect the tumor. Intraoperative fluorescence guidance can be divided into two types: endogenous contrast enhancement and exogenous contrast enhancement. Endogenous contrast enhancement is the use of autofluorescence to distinguish tumor tissue from surrounding normal tissue, so the boundary between normal tissue and tumor cell is not clear and reliable enough. After the exogenous contrast agent is irradiated with excitation light of corresponding wavelength, it can form a region with fluorescence gradient according to the concentration difference of fluorescent molecules, which is conducive to effective identification of tumor boundary. Its technical difficulty is greater and its application value is higher. With the progress of imaging equipment and fluorescent molecule preparation technology, the effect of FGS is constantly improved. At present, it has shown the advantages of accurate, fast and intuitive imaging^[1]It enables surgeons to safely remove tumors in real time under direct vision to the maximum extent, and at the same time brings new opportunities for tumor diagnosis and targeted therapy.

Glioma is the most common primary tumor of the central nervous system. Even with the most aggressive treatment, the prognosis of patients with high-grade glioma is not significantly improved^[1]。 Implementing individualized diagnosis and treatment is a necessary means to improve the efficacy and prognosis of glioma, and the prerequisite for achieving this goal is accurate diagnosis and evaluation. However, the heterogeneity of cytological origin of glioma makes its molecular phenotype, histological composition and biological behavior varied. At present, the "gold standard" of glioma diagnosis is pathological diagnosis, and imaging is needed to accurately display the morphological structure of tumor and evaluate its biological behavior during the localization of pathological biopsy, the determination of treatment plan and the follow-up^[2]。 Routine MRI and enhanced MRI can provide information such as tumor size, peritumoral edema, tumor perfusion, etc. It plays an important role in the imaging diagnosis of glioma^[2]。 However, low-grade glioma is sometimes difficult to distinguish from non-neoplastic lesions because of small tumor body, insignificant enhancement and light space occupation effect. The boundaries of diffusely growing high-grade gliomas are often not clearly shown by enhancement; Non-specific enhancement caused by blood-brain barrier disruption brings illusions to the diagnosis and classification of glioma^[3,4]； Tumor recurrence or progression is often difficult to distinguish from post-treatment changes (including radionecrosis and pseudoprogression). In recent years, a variety of MRI imaging methods have been applied to the study of brain tumors, including diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI), perfusion weighted imaging (PWI), hydrogen proton magnetic resonance spectroscopic imaging,¹H-MRSI) and the like. PWI can show regional cerebral blood flow, but the perfusion itself is low in low-grade gliomas, while the destruction of the blood-brain barrier caused by inflammatory reactions, surgery, and post-radiotherapy injuries can lead to increased non-specific perfusion of lesions.¹H-MRSI provides partial metabolic information, but has limited value in the assessment of structures close to the scalp and ventricles, as well as calcified or bleeding lesions^[5]。

parkinsonism-hyperthermia syndrome (PHS) is a movement disorder emergency, which refers to a fatal central dopaminergic deficiency crisis that occurs within hours to days during the reduction, withdrawal or drug switching of dopaminergic drugs in patients with Parkinson's disease. It is mainly manifested as high fever, muscle rigidity (may not be accompanied by tremor), autonomic dysfunction (including tachycardia, blood pressure fluctuations, hyperhidrosis, etc.), and disturbance of consciousness.^[1]。 Complications include permanent neurological sequelae, acute kidney injury, aspiration pneumonia, deep vein thrombosis and pulmonary embolism, disseminated intravascular coagulation, etc. The mortality rate is about 4%^[2]。 Because its clinical manifestations are similar to antipsychotic drug withdrawal reactions, it is also called malignant withdrawal syndrome. This article reviews PHS related to deep brain stimulation (DBS), aiming to enable neurological, surgical and neurorehabilitation physicians to identify this potentially fatal syndrome in a timely manner.

diabetic peripheral neuropathic pain (DPNP) is one of the important factors affecting the quality of life of diabetic patients. About 30% to 50% of diabetic patients will develop diabetic peripheral neuropathy (DPN), and more than 20% of them can develop DPNP^[1]。 Peripheral nerves can change the biological activity of neurons and demyelinating lesions under long-term hyperglycemia, which leads to different types of sensory abnormalities in patients. It often manifests as hyperalgesia in the early stage, hypoesthesia in the late stage, and eventually refractory ulcers due to the lack of protective sensation, which may even require amputation treatment in severe cases. The prevention and treatment of DPNP is difficult, and pain often seriously affects the quality of life of patients. There are various ion channels and receptors on human cells, including dorsal root ganglian (DRG) and spinal cord neurons, which participate in normal biological activities of the body through the exchange of substances and information inside and outside the cell. At present, there are more and more research reports on ion channels and diabetes and pain, but there are few comprehensive research reports from three aspects: ion channels, diabetes and peripheral neuralgia. This article summarizes them as follows.