2018年 · 第34卷第10期

Since the American Heart Association published the "Recommendations for the Management of Intracranial Arteriovenous Malformations" (2001 edition statement) in 2001^[1]Over the past decade, people have gained more knowledge about brain arteriovenous malformations (bAVMs). Therefore, the American Heart Association organized relevant experts to search the literature included in PubMed, Medline and Embase from the 2001 edition of the statement until the end of January 2015, reviewed the existing data, supplemented and revised the 2001 edition of the statement, and issued a new bAVMs treatment statement in 2017-"Management of Intracranial Arteriovenous Malformations" (referred to as the 2017 edition statement)^[2]。 Since 2001, we have accumulated new data on the epidemiology, biology, imaging and treatment of bAVMs, the most notable of which is the publication of the results of the first prospective randomized controlled trial of undisrupted bAVMs (ARUBA; multicenter, non-double-blind trial^[3]。 The 2001 edition statement pointed out that both Grade I and II recommendations need to be supported by the results of randomized controlled studies, but there were no studies that met the requirements at that time, so it was insufficient to provide Grade I and II evidence. Therefore, the results of the ARUBA trial received great attention in the 2017 edition of the statement. The 2017 edition stated that bAVMs was classified into two types, unruptured and ruptured, according to whether the first symptom was intracranial hemorrhage, and was described separately. Combined with the newly published literature at home and abroad, this paper interprets the contents of unruptured bAVMs in the 2017 edition of the statement.

traumatic spinal cord injury (tSCI) is a catastrophic disease that seriously harms young adults. It often leads to severe neurological injury and significant decline in quality of life, and causes a heavy burden on families and society. The main causes of injuries include accidental injuries such as car accidents, high altitude falls, falls, diving and skiing, etc.

Endovascular embolization has become one of the main methods for the treatment of intracranial aneurysms, and has achieved good results^[1,2]。 However, when the branch artery is closely related to the aneurysm, even from the neck or body side wall of the aneurysm, the branch artery needs to be preserved during the embolization process, which is a difficult problem in aneurysm embolization^[3,4]。 From January 2014 to January 2017, 6 patients with ruptured intracranial aneurysms involving branch arteries were embolized by coil support technique in the Department of Neurointervention, Beijing Chaoyang Hospital affiliated to Capital Medical University, with satisfactory results. The results are reported retrospectively below.

Anterior communicating artery aneurysms are common intracranial aneurysms, accounting for 1/4 of all intracranial aneurysms^[1]。 Rupture and bleeding of anterior communicating artery aneurysm can lead to dysfunction of corresponding blood supply area, and promote adhesion and spasm of surrounding blood vessels, which not only seriously affects the life safety of patients, but also limits the treatment of craniotomy^[1]。 Endovascular stent-assisted embolization has greatly improved the safety and effectiveness of coil embolization of anterior communicating artery aneurysms. This study retrospectively analyzed the clinical data of 34 patients with anterior communicating artery aneurysm treated with LVIS stent-assisted embolization, and evaluated its safety and efficacy by analyzing the degree of embolization, efficacy, complications and recurrence.

neurofibromatosis 2 (NF2) is an autosomal dominant disease caused by mutations in the NF2 gene, and its incidence is about 1 in 25 000^[1]。 NF2 can be manifested as bilateral vestibular schwannoma, subcutaneous schwannoma, cataract, meningioma, intraspinal schwannoma, etc^[2,3]。 Studies have shown that 45% ~75% of NF2 patients are accompanied by multiple intraspinal schwannomas. When the tumor enlarges, compressing the surrounding tissues can cause pain, limb sensory or motor disorders, urine and fecal incontinence and other symptoms, which affect the quality of life of NF2 patients^[4,5,6]。 Surgical treatment is the main treatment for intraspinal schwannoma in NF2 patients at present. At present, the research mainly focuses on the treatment of bilateral vestibular schwannoma caused by NF2, and there are few reports on the treatment of intraspinal schwannoma caused by NF2. This article retrospectively analyzed 37 patients with intraspinal NF2 admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from June 2004 to December 2015, and discussed their clinical symptoms, treatment methods and efficacy, which are summarized and reported below.

dural arteriovenous fistulae (DAVF) are complex lesions in cerebrovascular diseases. Because the cavernous sinus involves large intracranial vessels and multiple groups of cranial nerves, the treatment of DAVF in the cavernous sinus area is particularly difficult. With the continuous progress of endovascular therapy techniques and materials, the therapeutic effect of DAVF in cavernous sinus region has been greatly improved^[1,2,3]。 Although conventional endovascular treatment of DAVF in cavernous sinus can improve the clinical symptoms of most patients, it is easy to lead to recurrence due to the impossibility of complete embolization and the establishment of collateral circulation. The Brain Center of the Affiliated Hospital of Armed Police Logistics College has achieved good clinical results in the treatment of DAVF in the cavernous sinus area through superior ophthalmic vein approach since 1993. However, this approach needs to expose the superior ophthalmic vein. If the superior ophthalmic vein is thin and difficult to intubate, it will occasionally lead to rupture of the superior ophthalmic vein, and the postoperative wound is prone to edema and there is a risk of infection. Since 2007, the Brain Center of the Affiliated Hospital of Armed Police Logistics College has used the inferior petrosal sinus (IPS) approach to treat 37 cases of DAVF in the cavernous sinus area, and achieved good therapeutic results. The retrospective analysis is as follows.

With the aging of our population and the improvement of people's living conditions, cardiovascular and cerebrovascular diseases have replaced tumors as the first cause of death in our country, and their mortality rate is 4~5 times higher than that in European and American countries^[1]。 The incidence, disability and mortality of stroke are extremely high. Early detection of high-risk stroke groups, early intervention treatment and standardized management are of great significance to reduce or delay the occurrence of stroke^[2]。 The Brain Hospital of Liaocheng People's Hospital, as a stroke screening base and a carotid endarterectomy (CEA) training base, undertakes the screening of people over 40 years old in Liaocheng, Shandong Province. The screening results are summarized and analyzed as follows.

hemangiopericytoma (HPC) is a rare tumor of vascular origin, which occurs mainly in adults and children<10%^[1]。 Because of its low incidence, difficult preoperative diagnosis, abundant blood supply, and difficult surgical treatment, the treatment of HPC is extremely challenging. At present, there is no unified treatment standard in the world. A neonatal congenital frontal HPC was treated in the Department of Neurosurgery of Yangzhou University Affiliated Hospital in October 2012, and the prognosis was good. The report is now as follows.

PatientMale, 37 years old. The main reason was "20 years of defecation and urination disorders after suffering from Guillain-Barre syndrome (GBS)". The patient was diagnosed with GBS 20 years ago due to weakness of both lower limbs and urinary incontinence, and was given drug treatment, and the symptoms of weakness of both lower limbs were slightly improved. The patient has urinary incontinence, urinating about every 10 minutes, and sleeping enuresis at night; Constipation, about once every 7 days. The patient complained of abnormal sensation below the knee joint in both lower limbs, weakness in both toes and ankles, and forward leaning when walking. Poor sexual function. Admission physical examination: anal relaxation, anal reflex disappearance, dull pain stimulation around the anus about 20 cm, bilateral ankle muscle strength grade IV, bilateral toe muscle strength grade III. Bilateral knee tendon reflexes were slightly hyperactive, Achilles tendon reflexes were obtuse, and bilateral Babinski sign was positive. B-ultrasound of urinary system: the morphology of both kidneys, ureters and bladder was normal, and the residual urine volume of bladder after urination was 24 ml. Urodynamic findings: slightly dull sensation of the bladder, hyperactivity of the detrusor muscle, and decreased bladder compliance. Admission diagnosis: sequela of GBS-neurogenic bladder, refractory constipation. Neuromodulation was performed according to standard procedures^[1,2]。 Via left S₃The electrode was inserted into the sacral plexus and connected with the extracorporeal temporary sacral nerve modulator. The treatment for 2 weeks was satisfactory. The permanent sacral neuromodulator Intersim II (Medtronic, USA) was then installed (Figure 1)。 Stimulation parameters: frequency 14 Hz, pulse width 220 μ s, voltage 2 V. The patient had normal urination and defecation at 7 days after surgery, without urinary incontinence, enuresis or constipation. After 1 year follow-up, the patient had normal urine and defecation. Since 3 months after surgery, there was occasional enuresis during night sleep, but it could be avoided by restricting drinking and eating 4 hours before bedtime. B-ultrasound revealed that the ureter and bladder of both kidneys were normal and the residual urine volume was 0.

Ischemic stroke has a high incidence rate. In the United States, for example, 800,000 strokes occur every year, of which 610,000 are new strokes, and ischemic stroke accounts for 87%^[1]。 Large vessel occlusion (referring to the internal carotid artery, the main middle cerebral artery, the basilar artery and the intracranial vertebral artery) occupies a high proportion of ischemic stroke. An imaging evaluation of 2 152 patients with acute ischemic stroke performed by magnetic resonance angiography (MRA) or CT angiography (CTA) found that arterial occlusion was present in 1 043 patients (48.5%), including a total of 860 (40.0%) large vessel occlusions^[2]。 Occlusion of large vessels is closely related to the poor prognosis of stroke (modified Rankin scale score 3-6), and the poor prognosis rate of occlusion of large vessels without successful recanalization is as high as 91%-95%^[3]。 Intravenous thrombolysis is inefficient for recanalization of large vessel occlusion, and thrombus with a diameter of more than 8 mm can hardly be dissolved by tissue plasminogen activator (tPA) (<1%)^[4]。 In recent years, several large randomized controlled studies have confirmed the effectiveness of endovascular treatment for acute anterior circulation large vessel occlusion. Compared with intravenous thrombolysis alone, it has achieved higher recanalization rate and lower disability and fatality rate, and has become one of the main treatment modalities for acute ischemic stroke^[5,6]。 However, recanalization surgery is different from traditional surgery, and its recanalization time is crucial for surgical outcome. Early recovery of cerebral blood flow is the key to prevent permanent brain tissue damage. Recanalization time is closely related to prognosis. Rapid recanalization technology is of great significance for stroke patients undergoing endovascular therapy.

Glioma is the most common intracranial primary central nervous system tumor. It originates from glial cells, is invasive and highly heterogeneous, lacks a histological boundary that can be recognized by naked eye, and brings challenges to surgical treatment, pathological grading and prognostic evaluation^[1]。 Traditional neuroimaging (such as CT, MRI and other structural imaging) can provide information on anatomical location, size, shape and other information of tumor, and find indirect signs such as edema, hemorrhage and necrosis around tumor^[2]It plays a certain role in the diagnosis and differential diagnosis of glioma, but is insufficient in the classification, prognosis assessment and delineation of tumor scope. Positron emission tomography (PET) can provide metabolic information of lesions and explore the abnormalities of cellular molecules during tumor formation. Combined with traditional neuroimaging methods, it has certain advantages in early diagnosis, early treatment and delineation of tumor scope^[2,3]。

Glioma is the most common primary tumor of the central nervous system, with an incidence rate of more than 50% of intracranial tumors. The prognosis of patients with high-grade glioma is poor. Taking glioblastoma multiforme (GBM) as an example, the median survival of patients with adjuvant radiotherapy and chemotherapy after surgery is about 15 months^[1]While the median survival of low-grade gliomas is 4 to 15 years^[2,3]。 Traditional clinicopathological classification based on histological features, combined with immunohistochemical detection of relevant proteins, ultrastructure, etc. is no longer sufficient to explain the large differences in survival of patients with low-grade glioma. The latest research shows that low-grade gliomas also have different biological manifestations, some of which are indolent and progressing slowly; Another part rapidly progresses to GBM, while differences in differentiation depend on specific gene mutations^[4]。 In 2016, the new World Health Organization (WHO) classification of central nervous system (CNS) tumors introduced molecular parameters, changing the old principles mainly based on histogenesis and microscopic diagnosis. This article will briefly describe glioma genotyping and its guiding significance for prognosis evaluation and treatment, as well as the research progress of glioma marker genes.