2018年 · 第34卷第11期

pituitary adenoma occurs from the adenopituitary gland in the anterior lobe of the pituitary gland. It is one of the common intracranial tumors, accounting for about 10% of intracranial tumors. The incidence rate in women is slightly higher than that in men. Traditional pathological classification methods have found that some cases of pituitary adenoma are inconsistent with the clinical process, especially for the diagnosis of so-called chromophobic pituitary adenoma, there are still many problems to be solved, but ultramicropathology classification according to the morphology of hormone particles has its unique features^[1]。 The new World Health Organization (WHO) classification of nervous system tumors adds the characteristics of tumor genes and molecular genetics on the basis of morphology. This classification system is suitable for basic research on pituitary adenoma. In the 2017 version of the endocrine tumor classification, WHO combined specific hormones and transcription factors to classify pituitary adenomas according to cell differentiation lineages, so as to emphasize the source of cell differentiation and make people have a further understanding of the origin of pituitary adenomas^[2]。

medulloblastoma (MB) is one of the most malignant neuroepithelial tumors in the central nervous system^[1]The typical site of its occurrence is the cerebellar vermis at the midline. Non-midline MB is relatively rare and occurs more in adults than in children^[2]It mostly occurs in the cerebellar hemisphere and is very rare in other parts. This article retrospectively reports the diagnosis and treatment of 4 patients with non-midline MB confirmed by pathology admitted to the Department of Neurosurgery of the First Affiliated Hospital of Chongqing Medical University from January 2014 to January 2017 as follows.

With the continuous development of neuroendoscopic technology, neuroendoscopic transnasal enlargement approach has received more and more attention in skull base surgery. In recent years, neurosurgeons have begun to use this approach to remove craniopharyngiomas^[1]It shows advantages and limitations compared with traditional craniotomy in the therapeutic effect. From February 2013 to October 2017, 21 patients with craniopharyngioma were resected by neuroendoscopic expanded nasal approach in the Department of Neurosurgery of the Second Hospital of Lanzhou University. Combined with relevant literature at home and abroad, the clinical data and diagnosis and treatment experience are retrospectively summarized as follows.

Intracranial basal ganglia is the best site of hypertensive cerebral hemorrhage. After hemorrhage, the cortical spinal tract (CST) of the hind limb of the inner capsule is compressed, displaced and damaged, resulting in partial or complete loss of motor function. The presence of hematoma can lead to perihematomal edema (PHE) through physical and chemical pathways. It has been reported in the literature that the degree of PHE occurrence is closely related to the amount and time of hematoma. The occurrence and development of PHE can lead to the deterioration of the disease and further damage of motor fibers^[1,2]。 minimally invasive surgery (MIS) is a mature surgical method in recent years. Through stereotactic insertion of a catheter into the hematoma cavity, the purpose of aspiration and drainage of the hematoma is achieved, and the life of the patient is saved, while secondary brain injury is reduced. With the development of MRI technology, diffusion tensor imaging (DTI) technology can intuitively analyze and judge CST damage. By calculating the fractional anisotropy (FA) value of CST in the basal ganglia region, the integrity and damage of CST were analyzed objectively. At present, there are few reports on the effects of minimally invasive treatment on PHE and CST in patients with basal ganglia hemorrhage. From February 2014 to January 2016, 34 patients with basal ganglia hemorrhage were treated with MIS in the Department of Neurosurgery of Huzhou Central Hospital. The effect of MIS on PHE and CST in patients with basal ganglia hemorrhage was evaluated by DTI, which is reported as follows.

Ventricular hemorrhage is a common type of cerebral hemorrhage disease, accounting for about 45%. Its mortality and disability rate are high, and the cause is mostly hypertension^[1,2]。 Ventricular hemorrhage includes both primary and secondary ventricular hemorrhage. Among them, the clinical manifestations and prognosis of primary ventricular hemorrhage and ventricular hemorrhage secondary to a small amount of cerebral parenchymal hemorrhage are often different from cerebral parenchymal hemorrhage, and the routine treatment with external lateral ventricular drainage still has a high mortality rate^[3,4]。 Neuroendoscope has the advantages of good illumination and multi-angle visual field, and has unique advantages in ventricular hemorrhage surgery. This study included 87 patients with hypertensive ventricular hemorrhage who were treated with neuroendoscopic surgery or external ventricular drainage, respectively, and compared the advantages and disadvantages of the two methods in the treatment of hypertensive ventricular hemorrhage.

Brainstem gliomas usually originate from the pons, followed by the midbrain, medulla oblongata, cerebral foot, and cervical spinal cord; It is further divided into diffuse type, exogenous type, extended ridge type and localized endogenous type. Tectal tumor is a special type of localized brainstem tumor, which has its special clinical manifestations and treatment measures. diffuse intrinsic pontine gliomas (DIPG) are second only to exophytic tumors, which together account for 85% of brainstem tumors. Each of these subtypes has its own unique clinical manifestations, imaging findings, and outcomes. DIPG had poor prognosis, while tectal and longitudinal gliomas had longer survival^[1]。 This article retrospectively analyzes the clinical data of a patient with brainstem glioblastoma who was treated with standardized treatment in the Department of Neurosurgery, Tangdu Hospital, Air Force Medical University in July 2013. At present, the follow-up has ended and is reported as follows.

The primitive trigeminal artery, also known as the persistent trigeminal artery, is an embryonic anastomosis between the internal carotid artery and the basilar artery^[1]It is a rare vascular variation. Rupture of the original trigeminal artery due to traumatic or spontaneous causes can cause a cavernous fistula of the original trigeminal artery. In November 2015, a patient with spontaneous primitive trigeminal cavernous fistula was admitted to the Department of Neurosurgery of Subei People's Hospital of Jiangsu Province, and endovascular treatment was given with good efficacy. The report is now as follows.

Meningioma is a common primary central nervous system tumor in the cranium, accounting for 36.6% of primary central nervous system tumors, and the incidence of meningioma is about 8.3/10 000^[1]。 This disease is mainly benign clinical manifestations, and a few meningiomas show local malignant biological behaviors. Recently, there are more and more studies on meningioma subtypes with related malignant clinical manifestations, but the probability of meningioma metastasis is extremely low, about 1/1 000^[2]Therefore, there are few reports on the metastasis of meningioma at home and abroad. In August 2007, a patient with lung metastasis of meningioma was admitted to the Department of Neurosurgery of Xiangya Hospital of Central South University. The report is as follows.

Chordoma is a rare bone tumor, accounting for about 3% of all bone tumors. It is mostly considered to be the source of residual chordal tissue. It has some characteristics of sarcoma: including relatively low mitotic activity and cell proliferation rate; But has a higher risk of local recurrence and metastasis^[1]。 Therefore, it is often recognized as sarcoma, and the treatment of sarcoma is mostly followed or referred to. The annual incidence rate of chordoma is about 0.51~8/million people, and the prevalence rate of the population is less than 1/10. It can occur at any age, and the peak incidence is 50~70 years old. Chordoma has the characteristics of insidious onset, mostly slow growth, and often has grown for many years before diagnosis. The onset sites are more common in the spine and skull base, and skull base chordoma accounts for 1/3 of all chordomas. Because of its deep location and adjacent to many important neurovascular structures, skull base chordoma makes surgical treatment difficult, and the proportion of in situ recurrence or residual tumor regrowth is high. In addition, 30% ~40% of patients can have dissemination or distant site metastasis, and spinal chordoma is more common (20% ~40%); The proportion of skull base chordoma metastases is relatively low (<10%), dissemination is more common^[2]。 Although some patients with chordoma have a long survival period, more than 50% of them have a poor prognosis due to recurrence or metastasis dissemination^[3]。 In recent years, with the application of many technical means and devices and the in-depth research on the pathogenesis, the treatment of chordoma has made a lot of progress. This article reviews the comprehensive treatment progress of skull base chordoma (hereinafter referred to as chordoma).

Gliomas are the most common primary tumors in the cranium, accounting for approximately 45% of all intracranial tumors. Even with the combination of surgery, radiotherapy and chemotherapy, some patients with glioma still progress rapidly and will relapse in a short time after surgery. How to identify these patients and adopt active treatment to improve their prognosis is an urgent problem^[1,2,3]。 With the development of molecular biology and molecular genetics, people have a deeper understanding of the occurrence and development of glioma^[2,4]。 However, there are temporal and spatial heterogeneity in the process of tumor occurrence and development. Therefore, it is difficult to fully reflect the biological characteristics of tumor by molecular genetic detection based on local tumor tissue^[5]。 Imaging can provide a more comprehensive view of the tumor, and it can also provide dynamic information to help monitor tumor growth, evolution, and treatment response^[6]。 In recent years, with the advancement of imaging extraction and post-processing technology, the research of radiomics in the field of glioma is gradually heating up. It can enable researchers to obtain more objective, quantitative and indistinguishable image features, and then comprehensively describe the morphological differences caused by the genetic changes of tumors^[7,8]It provides a new method for accurate diagnosis and treatment of glioma patients. The author reviews the concept of radiomics, its clinical application in glioma and its challenges.

Cerebral palsy, referred to as cerebral palsy for short, is caused by non-progressive brain injury such as congenital (malformation, intrauterine infection) or acquired (premature birth, low birth weight, asphyxia, hypoxic ischemic encephalopathy, kernel jaundice, trauma, infection) of the immature brain, and its prevalence is about 2‰ ~3.5‰^[1]。 The main manifestations are central motor, postural development disorders and limited activities, with or without sensory, perceptual, cognitive, communication and behavioral disorders, as well as epilepsy and secondary muscle and bone problems, which seriously affect the growth and development of children, make them unable to live independently, and bring a heavy burden to their families and society. Cerebral palsy is divided into spastic type, involuntary movement type, ataxia type and mixed type according to the type of movement disorder; Among them, spastic type is divided into spastic quadriplegia, spastic diplegia and spastic hemiplegia; The involuntary movement types are divided into athetoid and dystonia types. The spastic cerebral palsy is mainly damaged by pyramid system; Involuntary movement type is mainly damaged extrapyramidal system; The ataxia type is mainly cerebellar damage; Mixed type is two or more types of clinical manifestations existing simultaneously, mostly one type of manifestation is the main^[1]。 The diagnosis and treatment of cerebral palsy involves pediatrics (neurology), rehabilitation, neurosurgery, orthopedics and other disciplines. The treatment of all types of cerebral palsy is mainly based on rehabilitation. Long-term and regular rehabilitation training is the most important method for treating cerebral palsy. Neurosurgery is mainly to improve muscle tone, create conditions for rehabilitation treatment or as a supplementary means, and long-term systematic training is still needed after operation. This article mainly reviews the neurosurgical treatment of cerebral palsy.

With the development of emergency and critical care technology, the survival rate of patients with craniocerebral injury has been greatly improved. More and more patients are turning from severe coma to disturbance of consciousness. Disorders of consciousness are a major dilemma in the field of neuroscience and neurosurgery. Disorders of consciousness can be divided into different levels, and distinguishing different levels is challenging, with a 40% misdiagnosis rate if assessed according to behavior. The lack of response to the outside world by patients with consciousness disorders does not necessarily mean that they are unconscious, but how much consciousness and function remain, and to what extent it can be recovered, are urgent questions to be answered.