2018年 · 第34卷第05期

The "complexity and refractory treatment" of intracranial aneurysm is a relative concept, which depends on the cognition degree and the technical level of diagnosis and treatment of intracranial aneurysm in medical circles in different eras. From the earliest simple morphological description of Imhotep to today's in-depth mechanism research in molecular pathology and hemodynamics; From the simple carotid artery ligation for the treatment of intracranial aneurysms to the establishment of advanced multimodal treatment strategies and technological platforms today, the concept and type of "complex and refractory" intracranial aneurysms in the past have changed, and now they have become routine and general surgery. Nevertheless, the complexity and difficulty of treatment in the modern sense still lie ahead and need us to constantly challenge.

eating epilepsy (EE) belongs to reflex epilepsy (RE) and is a rare epileptic syndrome. EE has a poor response to anti-epileptic drugs, and the risk of hemiplegia caused by surgical treatment of EE of central tegus origin is high. EE is a difficult treatment point in epilepsy surgery. The Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with EE in March 2014, and was treated with vagus nerve stimulation (VNS). The follow-up was 3 years and 6 months, and the postoperative epilepsy remission rate reached 87.5%. Combined with relevant literature, the symptomatic characteristics, pathogenic mechanism and neuromodulation therapeutic effect of EE are summarized and reported as follows.

A distal anterior choroidal artery (AChA) aneurysm refers to an AChA aneurysm that is entirely located in the AChA, not the internal carotid artery. The aneurysms are mostly secondary aneurysms, usually combined with moyamoya disease or local cerebrovascular malformation^[1,2]。 Distal aneurysms of AChA are extremely rare. After literature search, only a few dozen cases have been reported worldwide^{[3,4,5,6,7,8,9,10,11]}； However, only 9 cases of distal AChA aneurysm in the cisternal segment have been reported worldwide, and only 1 case has been reported in China^{[6,7,8,9,10,11]}。 From January 2003 to May 2017, the Department of Neurosurgery of Fuzhou General Hospital treated a total of 3,130 patients with intracranial aneurysms, including 6 cases of internal carotid artery-ACHA bifurcation aneurysms, and only 1 case (0.3‰) of AChA distal cisternal segment aneurysm. Combined with the literature, the clinical characteristics and diagnosis and treatment measures of this case of AChA distal cisternal segment aneurysm are retrospectively reported as follows.

The rapid development of modern neurosurgery is closely related to high-tech innovation. From the advent of CT and surgical microscope in the 1970s, to magnetic resonance imaging (MRI) in the 1980s, and surgical navigation technology in the 1990s, they are all great driving forces to promote the development of neurosurgery. Due to the particularity of nervous system diseases and the non-regenerability of nervous tissue, neurosurgeons have always pursued the accuracy and minimally invasive nature of surgery for a long time; At the same time, neurosurgeons are a new force in transforming high-tech into clinical medicine. Some high-tech new technologies have been quickly adopted clinically once they appear, such as surgical microscope, surgical navigation, etc. In contrast, the application and development of spinal spinal surgical navigation is relatively slow, which is related to the following factors: (1) Poor accuracy of surgical navigation. (2) Surgical login is time-consuming. (3) Real-time X-ray verification is still needed during operation. (4) Increased cost and prolonged operation time, etc. This article reviews the progress in the application of surgical navigation in spinal cord diseases.

Epilepsy is a central nervous system disease caused by abnormal neuronal discharge. It has the characteristics of seizure, transience, repetition and stereotype, which seriously endangers the physical and mental health of patients^[1]。 The prevalence of epilepsy is 0.7% ~3%, and 20% ~30% of epilepsy patients cannot control their seizures after standardized treatment, which is refractory epilepsy^[2]。 deep brain stimulation (DBS), as a neuromodulation technique, can effectively control epileptic seizures by implanting electrodes at specific targets, giving appropriate electrical stimulation, and regulating the functional activities of brain tissue, and can improve the cognitive level of patients to a certain extent. It is a relatively safe, reversible and adjustable neuromodulation technique^[3,4]。