2018年 · 第34卷第12期

In recent years, the rapid progress of epilepsy surgery is mainly reflected in the rapid development of stereoscopic electroencephalography technology and image post-processing technology. The reason why the latter has received more and more attention is that magnetic resonance imaging (MRI) negative partial epilepsy is a major challenge in preoperative evaluation. According to statistics, 30% and 25% ~45% of patients with temporal lobe epilepsy and frontal lobe epilepsy are classified as MRI-negative epilepsy, respectively. Cortical developmental malformations are the most common pathological type of childhood epilepsy and the third most common pathological type of adult epilepsy. Similarly, 20% ~30% of cortical developmental malformations are MRI-negative^[1,2,3]。 Medical image post-processing technology can assist in screening intracranial abnormal lesions through computer processing, improve the detection rate of MRI negative epileptogenic lesions, and help to improve the preoperative evaluation efficiency and surgical prognosis of epilepsy surgery.

Parasitic diseases of central nervous system are a part of systemic parasitic diseases, which are a special kind of infectious diseases caused by parasites invading the cranium. Ventricular parasitic diseases accounted for 12.0% ~18.0% of cerebral parasitic diseases, and most patients were seen because of hydrocephalus^[1]。 In the past, ventricular-peritoneal shunt was used in the treatment of ventricular parasitic diseases with hydrocephalus, but the rate of tube occlusion was high, and the surgical effect was poor^[2]。 From June 2011 to April 2017, 12 patients with ventricular parasitic disease complicated with hydrocephalus were treated with neuroendoscopy in the Department of Neurosurgery of Guizhou Provincial People's Hospital, and good results were obtained. The retrospective summary report is as follows.

The traditional standard traumatic large bone flap decompression surgery has a wide range of indications, and it is basically used in clinical practice for patients with severe craniocerebral injury. Because its bone flap is large enough and decompression is sufficient, it can remove the hematoma of frontal and temporal lobes at the same time^[1]So it has been widely recognized by neurosurgeons at home and abroad. Jiang Jiyao et al.^[2]A prospective clinical multicenter controlled study showed that standard traumatic large bone flap craniotomy is better than conventional temporoparietal bone flap craniotomy in the treatment of patients with severe cerebral contusion and laceration, cerebral edema and malignant intracranial hypertension. However, in practical application, although patients with frontotemporal craniocerebral injury have different focal points and different injury mechanisms, the decompression of the temporal part is more important than that of the frontal part for the relief of intracranial hypertension^{[1,2,3,4,5,6,7]}。 How to reduce the defect of the forehead skull caused by the removal of the forehead bone flap has clinical significance. At present, many scholars have recognized this problem and tried to improve it^[3,4,5,6,7]。 From January 2007 to December 2017, the Department of Neurosurgery of Xing'an League People's Hospital, on the basis of summarizing the application of standard traumatic large bone flap decompression surgery, explored the method of routinely removing intracranial hematoma and then enlarging the temporal bone flap while retaining the frontal bone flap. A total of 112 patients with craniocerebral injury were treated, and good clinical results were achieved. The retrospective analysis is as follows.

carotid endarterectomy (CEA) is effective in preventing ischemic stroke and improving blood flow to brain tissue^[1]。 carotid artery stenting (CAS) has been used in the treatment of carotid artery stenosis since 1990s. It has the advantages of less trauma, fast recovery and short time consumption, and is a better alternative treatment for patients with carotid artery stenosis who cannot undergo CEA.

Teratoma is a kind of germ cell tumor, which is mostly located in the lumbar vertebra in the spinal canal, especially in the cone. Cervical spinal cord involvement is rare, cervical spinal cord teratoma is extremely rare, only a small number of reports^{[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]}(Table 1)。 Intramedullary teratomas involving both the cervical spinal cord and the medulla oblongata are rarely reported at present, so it brings severe challenges to clinical treatment. In October 2017, a case of cervical bulbar intramedullary teratoma was admitted to the Department of Neurosurgery, Peking University Third Hospital. The report is as follows.

Medulloblastoma is the most common malignant invasive tumor in children, accounting for about 25% of childhood brain tumors. It is highly malignant, histologically consistent with the World Health Organization (WHO) central nervous system tumor grade IV, and is easily transmitted through cerebrospinal fluid. At present, due to the lack of objective and effective prognostic evaluation methods and related diagnosis and treatment standards, some children receive over-treatment or under-treatment, resulting in serious complications or poor prognosis^[1,2,3]。 The latest research found that medulloblastoma can be divided into four molecular subtypes according to the different activated signaling pathways, including WNT, SHH, Group 3 and Group 4 subtypes. These four molecular subtypes have significant differences in biological manifestations, clinical characteristics and prognosis^[1,2,3]。 Therefore, there is an urgent need to establish risk classification based on molecular biological characteristics and carry out individualized treatment strategies. Previous studies have combined the molecular typing of medulloblastoma with preoperative metastasis, chromosome imbalance and other factors for risk assessment, in order to improve the survival prediction level of patients with medulloblastoma. At the same time, targeted therapies for different molecular subtypes are also gradually carrying out clinical trials. This paper focuses on the recent advances in molecular biology of medulloblastoma, which have received extensive attention in recent years, and makes a review.

Cerebral palsy, also known as Little disease, refers to a group of syndromes of movement disorders and postural abnormalities caused by non-progressive brain defects or damages in the developing fetus or infants within 1 month after birth, often accompanied by sensory, perceptual, cognitive, communication, behavioral disorders and epilepsy^[1]。 Cerebral palsy can be divided into 6 types according to the type of movement disorder and the paralysis site^[2]: spastic quadriplegia, spastic diplegia, spastic hemiplegia, involuntary movement type, ataxia type and mixed type. Spastic cerebral palsy is the most common subtype, accounting for about 2/3 of all cases. At present, the treatment of spastic cerebral palsy needs multi-disciplinary cooperative intervention, mainly including rehabilitation training, drug treatment and surgery^[3]。 Rehabilitation treatment mainly includes occupational therapy, physical therapy and language training, which occupies a major position in the treatment of cerebral palsy. The primary objective of pharmacological intervention is to reduce spasticity, including oral medication (benzodiazepines, baclofen), botulinum A toxin (BTX-A) and intrathecal baclofen (ITB), indicated for mild to moderate spasticity. Surgical treatment methods include selective posterior rhizotomy (SPR), selective peripheral neurotomy (SPN), carotid artery sheath sympathetic network dissection, bone and muscle tendon orthopedics^[4]。 SPR is currently recognized as a surgical method that can effectively relieve limb spasm^[4,5]。 The damage of the cerebral hemisphere in children with spastic cerebral palsy leads to the decrease of impulses to the intermediate nerve of the spinal cord, the enhancement of the activity of gamma motor neurons, and the abnormal increase of excitability of alpha motor neurons caused by the gamma-loop through the positive feedback mechanism, thus leading to muscle spasm. SPR relieves limb spasm by reducing the excitability of alpha motor neurons and interrupting the positive feedback of distraction reflex^[6]。 SPR has been widely used because of its effectiveness and safety, and the recent research on SPR is reviewed.

cerebral cavernous malformations (CCM) are common intracranial vascular abnormalities, second only to intracranial arteriovenous malformations. CCM is a cavernous vascular mass composed of a single layer of endothelial cells, and there is no nerve tissue between the vascular lacunae. The clinical manifestations are closely related to the lesion site, and the main manifestations are epilepsy and hemorrhage. In the development history of CCM treatment strategies, most of them focused on surgical interventions such as surgical indications, surgical timing and surgical approach selection. After nearly 80 years of development, surgery is effective in treating CCM with repeated bleeding and superficial lesions^[1]。 However, for patients with familial multiple CCM, surgery cannot completely remove all lesions, and its value is limited; In some patients, the tumor is deep or adjacent to important nerve and vascular structures, and the surgical risk is greater. For such patients, non-surgical treatment modalities are of great significance. Unfortunately, the efficacy of radiotherapy in the treatment of CCM is controversial^[2]。 As the understanding of CCM continues to deepen, scholars realize that drug therapy targeting mutant genes and related signaling pathway molecules can help solve this problem, and have actively explored it. This article will review the pathogenesis of CCM and the basic or clinical research progress of its drug therapy in recent years.