Efficacy of microscopic decompression in degenerative lumbar spinal stenosis under single percutaneous tubular retractor system / 中华神经医学杂志

Objective:To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system.Methods:A retrospective analysis was performed; 117 DLSS patients with imaging manifestations as non-segmental lumbar instability, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system. These patients were followed up for 6-50 months. Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays, CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up. Modified MacNab criteria were used to evaluate the efficacy at the last follow-up. Results:Among the 117 patients, unilateral laminectomy for unilateral decompression was performed in 56 patients (47.9%) and unilateral laminotomy for bilateral decompression in 61 (52.1%). Single segment decompression was performed in 109 patients (93.2%) and double segment decompression in 8 (6.8%). Dural sac rupture occurred in 4 patients (3.5%), and immediate occlusion was given; no cerebrospinal fluid leakage was noted after decompression. All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression. After 18 (13, 24) months of follow-up, VAS scores of the patients at the last follow-up decreased from (5.96±0.85) 1 d before decompression and (1.75±0.61) 1 week after decompression to (1.01±0.59), and lumbar ODI decreased from (63.22±8.33)% 1 d before decompression and (17.66±5.20)% 1 week after decompression to (10.64±3.44)%, with significant differences ( P<0.05). At the last follow-up, modified MacNab criteria indicated 46 patients (39.3%) as excellent, 66 (56.4%) as good, 3 (2.6%) as fair, and 2 (1.7%) as poor, with an excellent/good therapeutic rate of 95.7%. Conclusion:For surgical treatment of DLSS patients without evidenced preoperative spinal instability, personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results.

Comparison of psoas major muscle morphology in patients with lumbar disc herniation of lower limb pain and lumbocrural pain / 中华神经医学杂志

Objective:To compare the morphological differences of psoas major muscles between patients with lumbar disc herniation (LDH) of lower limb pain and lumbocrural pain based on CT imaging data.Methods:Sixty patients with LDH admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistic Team from January 2012 to February 2023 were included. According to clinical symptoms, they were divided into lower limb pain group and lumbocrural pain group ( n=30). 3D CT images of the psoas major muscles in the 2 groups were reconstructed; the longest transverse axis perpendicular to the longitudinal axis of the psoas major muscle was chosen as the cross-sectional area, and the maximum psoas major muscle cross-sectional area was calculated; maximum psoas major muscle cross-sectional area index (PI max) was defined as ratio of maximum psoas major muscle cross-sectional area and L 5 vertebral cross-sectional area. PI max difference between lower limb pain group and lumbocrural pain group was compared; PI max difference among patients with different pain degrees (visual analog scale [VAS] scores) or pain courses was further compared in both lower limb pain group and lumbocrural pain group. Pearson correlation was used to analyze the correlations of PI max with pain degree and pain course in the 2 groups. Results:PI max in lower limb pain group was significantly larger than that in lumbocrural pain group (0.62±0.05 vs. 0.54±0.04, t=7.320, P<0.001). PI max in patients with severe pain from both lower limb pain group and lumbocrural pain group was significantly smaller than that in patients with moderate pain (0.61±0.05 vs. 0.65±0.04, t=2.422, P=0.022; 0.53±0.03 vs. 0.58±0.04, t=3.502, P=0.002). PI max in patients with short pain course from both lower limb pain group and lumbocrural pain group was significantly larger than that in patients with long pain course (0.64±0.05 vs. 0.59±0.04, t=2.570, P=0.016; 0.57±0.04 vs. 0.53±0.03, t=2.941, P=0.007). Pearson correlation showed that PI max was negatively correlated with pain degree and pain course in LDH patients from both groups ( P<0.05). Conclusion:Atrophy of psoas major muscles in LDH patients is aggravated with increased pain degree and pain course.

Research progress in the pathogenesis, diagnosis and treatment for posttraumatic acute diffuse brain swelling / 中华创伤杂志

Posttraumatic acute diffuse brain swelling (PADBS) is a relatively common severe traumatic brain injury (TBI). Since it can lead to acute intracranial hypertension in a short time, the illness can be acute and critical, with a high disability and fatality rate. The pathogenesis of PADBS is still unclear, with the current theory consisting of acute cerebral vasodilation, cerebral edema and intracranial venous circulation disorder. For PADBS, there is still a lack of unified diagnostic criteria, and the indications and timing of decompression craniectomy remain controversial. The authors review the research progress in the pathogenesis, diagnosis and treatment of PADBS, hoping to provide some new ideas for its treatment.

Application of multimodal ultrasound in large craniotomy for patients with severe traumatic brain injury: research progress / 中华创伤杂志

With the progression of primary and secondary brain injury, as well as the increase of the intracranial pressure, severe traumatic brain injury (sTBI) patients, if not timely and effective treated, will lead to brain hernia or even central failure. Therefore, sTBI patients often require emergency surgical intervention, including large craniotomy or even decompression. However, postural changes, brain tissue pulling and loss of cerebrospinal fluid can cause "brain drift" in sTBI patients. Meanwhile, improper rapid decompression will result in brain tissue displacement or delayed hematoma, which makes the intracranial condition deviated from the preoperative image data, even leads to deterioration. The application of multimodal intraoperative ultrasound can simply, intuitively visualize the intracranial lesion, blood flow and microperfusion in a real-time manner, guiding the surgeon to preserve the normal brain tissue to the maximum extent and improving the prognosis of the patients with the appropriate operation plan. Over the last few decades, the application of multimodal ultrasound in large craniotomy in patients with sTBI was mainly to identify intracranial lesions while there were few studies on the evaluation of cerebral hemodynamic heterogeneity of sTBI. To this end, the authors reviewed the imaging characteristics of various examination techniques of multimodal ultrasound and the progress of its application in sTBI surgery, hoping to provide evidences for accurate intraoperative evaluation and adjustment of treatment plan.

Treatment of cervical spondylotic radiculopathy with spinal nerve root decompression under microscope and percutaneous tubular retractor system / 中华神经医学杂志

Objective:To investigate the efficacy of posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system in cervical spondylotic radiculopathy (CSR).Methods:A total of 38 patients with CSR, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from September 2019 to October 2022 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system. The patients were followed up for (15.71±7.50) months, ranging from 3 to 36 months. The pain visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores were recorded and the results of X-ray, CT and MRI of cervical spines were analyzed 1 d before decompression, before discharge and at the last follow-up. C 2-7 sagittal vertical axis (SVA) was measured and compared on CT reconstruction images before decompression and at the last follow-up. The clinical efficacy of these patients was determined according to the formula of improvement rate=([JOA at the last follow-up-preoperative JOA]/[17-preoperative JOA])×100%: 100% improvement rate was defined as cure, improvement rate>60% as significant effect, 25%<improvement rate≤60% as valid treatment, and improvement rate≤25% was defined as invalid treatment. Results:The VAS and JOA scores were 5.91±0.90 and 11.37±1.50 before decompression, and 0.37±0.31 and 15.76±1.44 at the last follow-up, respectively, with significant differences ( P<0.05). Among 38 patients, 12 patients (31.6%) were cured, 18 (47.4%) were significantly effective, 7 (18.4%) were valid, and 1 (2.6%) was invalid, enjoying a total effective rate of 97.4%. Neither dural sac tear or obvious nerve injury during decompression nor infection after decompression were noted. The C 2-7 SVA at the last follow-up ([15.82±0.95] mm) was significantly lower than preoperative C 2-7 SVA ([17.07±1.07] mm, P<0.05). Conclusion:Posterior cervical nerve root decompression can obtain satisfactory results in single segment CSR; combined application of microscope and percutaneous tubular retractor system can effectively ensure the cervical spine stability and retain the corresponding motion segments.

Recent advance in pituitary neuroendocrine tumor invading dura mater / 中华神经医学杂志

Pituitary neuroendocrine tumors (PitNETs) are benign tumors arising from the adenohypophysis and can destroy the surrounding dura mater and invade adjacent structures. Dural invasion, as an important biological manifestation of PitNETs invasiveness and an important basis for PitNETs pathological classification, has become an important part in invasive study of PitNETs. In this paper, the research progress of dural invasion of PitNETs carried out at home and abroad in recent years has been reviewed from aspects of anatomical structure, imaging manifestations and histopathology, and the latest results of dural invasion in PitNETs invasion are summarized.

Recent advance in cognitive function in patients with pituitary neuroendocrine tumors / 中华神经医学杂志

Pituitary neuroendocrine tumors (PitNETs) are the second common central nervous system tumors. Patients often present with headache, vision loss, visual field defects, and cognitive dysfunction. Cognitive function is the ability of the brain to acquire, analyze and process external information; once the patient has serious cognitive dysfunction, it will bring heavy burden to the family and society. This article summarizes the cognitive functions in patients with PitNETs from perspectives of hormone, anatomical structures around the pituitary, tumor volume, treatment, and cognitive function assessment, in order to provide research ideas in elucidating relevant mechanisms in the future and provide basis for formulating rehabilitation plans for patients.

NG2 cell proliferation and activation generate and maintain neuropathic pain in rats after spinal cord injury / 中华神经医学杂志

Objective:To investigate the role of NG2 cells in generating and maintaining neuropathic pain in rats after spinal cord injury (SCI).Methods:According to random number table method, 100 healthy adult male SD rats were divided into control group ( n=20, without any intervention), sham-operated group ( n=40, exposed T 10 segment without spinal cord impact) and SCI group ( n=40, exposed T 10 segment and constructed SCI model by improved Allen's method). One d before, and 14, 21 and 28 d after surgery, Von Frey fiber probe was used to detect the rat hindlimb mechanical withdrawal threshold (MWT); immunofluorescent staining was used to detect the proportion of NG2-positive cells in spinal dorsal horn cells; Western blotting was used to detect chondroitin sulfate proteoglycan (CSPG) expression in spinal dorsal horn of rats. Results:Fourteen, 21 and 28 d after surgery, SCI group had significantly lower hindlimb MWT, and significantly higher proportion of NG2-positive cells in spinal dorsal horn cells and CSPG expression in spinal dorsal horn than control group and sham-operated group ( P<0.05). One d before, and 14, 21 and 28 d after surgery, in SCI group, hindlimb MWT decreased firstly and increased secondly, proportion of NG2-positive cells in spinal dorsal horn cells increased firstly and decreased secondly, and CSPG expression in spinal dorsal horn increased firstly and decreased secondly. Except for those 21 and 28 d after surgery, hindlimb MWT, proportion of NG2-positive cells in spinal dorsal horn cells, and CSPG expression in spinal dorsal horn showed significant differences between each two time points ( P<0.05). In SCI group, hindlimb MWT was negatively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=-0.876, P<0.001), and CSPG expression was positively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=0.927, P<0.001). Conclusion:NG2 cell proliferation and increased CSPG expression secreted by NG2 cells in spinal cord tissues after SCI generate and maintain neuropathic pain.

Nasal symptoms after transsphenoidal surgery for pituitary lesions / 中华神经医学杂志

Objective:To analyze the clinical outcome of nasal symptoms in patients with pituitary lesions after transsphenoidal surgery by microscope.Methods:A perspective study was performed; 53 patients with pituitary lesions treated by transsphenoidal microsurgery in our hospital from March 2012 to January 2013 were enrolled. Sinonasal outcome test (SNOT)-22 was used to evaluate the nasal symptoms in these patients before surgery, and 1 week, 1 month and 4 months after surgery; Toyota and Takagi (T&T) olfactometer was used to evaluate the olfaction before surgery, and 1 week and 4 months after surgery.Results:Among the 53 patients, 47 were with pituitary adenoma and 6 were with Rathke cysts. The common postoperative nasal symptoms included olfactory disorder, nasal obstruction, runny nose, pain in the nasal cavity and dizziness. The total scores and 5-items scores of SNOT-22 in patients 1 week and 1 month after surgery were significantly higher as compared with those before surgery ( P<0.05); there were no significant differences in these scores between before surgery and 4 months after surgery ( P>0.05). The incidence of olfactory disorder in patients 1 week and 4 months after surgery was significantly higher than that before surgery ( P<0.05); the incidence of olfactory disorder in patients 4 months after surgery was decreased as compared with that 1 week after surgery, without significant difference ( P>0.05). Conclusion:Olfactory disorder can occur to some extent after transsphenoidal approach with slow recovery, which deserves the attentions.

Cerebral microcirculation disorder caused by microglia in inflammatory state and its pathogenic effect / 中华神经医学杂志

Microglia are the main immune cells of the central nervous system and an important part of neurovascular unit (NVU). Together with endothelial cells, pericytes, vascular smooth muscle cells, astrocytes and neurons, microglia form NVU. They play an important role in maintaining the integrity of blood-brain barrier (BBB), regulating cerebral blood flow (CBF) and maintaining basic brain function. Neuroinflammation mediated by microglia can lead to cerebral circulation disorder, which is related to the occurrence and development of a variety of nervous system diseases. This paper reviews the characteristics and subtypes of microglia, the relations of microglia with brain microinflammation and cerebral microcirculation, and the correlation of microglia with central nervous system diseases.

Protective effect of infliximab on neurological function and its related mechanism in mice after traumatic brain injury / 中华神经医学杂志

Objective:To investigate the effect of infliximab (IFX) on neurological function in mice after traumatic brain injury (TBI) and the role of nuclear factor-κB (NF-κB)/inducible nitric oxide lyase (iNOS) signaling in it.Methods:Seventy-two healthy adult male C57BL/6 mice were randomly divided into sham-operated group, TBI group, and TBI+IFX group ( n=24). The mouse TBI models were established by controlled cortical impact method. IFX (dissolved in normal saline at a concentration of 2.5 mg/mL and a dose of 10 μg/g) was administered intraperitoneally into the mice of TBI+IFX group 30 min after modeling once daily for 3 d; mice in the sham-operated group and TBI group were given the same amount of saline intraperitoneally at the same time points for 3 d. Neurological deficits (Garcia scores) were assessed one, 3 and 7 d after modeling; blood-brain barrier permeability was detected by Evans blue staining, and brain tissue water content was measured by dry and wet weight method; Nissl staining was used to detect the percentage of injured neurons in brain tissues; the percentage of apoptotic neurons was detected by Tunel staining; immunofluorescent double-labeling was used to detect the expressions of caspase-3 and neuronal nuclear antigen (NeuN) in neurons; immunohistochemical staining was used to detect the microglia marker ionized calcium binding adaptor molecule-1 (IBa-1) expression; ELISA was used to detect the expressions of inflammatory factors (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-6, interferon [IFN]-γ) and free radicals (oxygen free radicals [ROS], nitrogen free radicals [RNS]) in the brain tissues; and immunofluorescent staining and Western blotting were used to detect the expressions of nuclear factor (NF)-κB/inducible nitric oxide synthase (iNOS). Results:(1) One, 3 and 7 d after modeling, the Garcia scores showed significant differences among the three groups ( P<0.05); as compared with the TBI group, the TBI+IFX group had significantly increased Garcia scores 3 and 7 d after modeling ( P<0.05). (2) Three d after modeling, as compared with those in the TBI group, Evans blue leakage ([18.45±1.32] μg/g vs. [16.38±1.25] μg/g), brain water content ([81.56±0.96]% vs. [79.97±0.79]%), percentage of injured neurons ([79.50±5.85]% vs. [68.81±7.47]%), and percentage of apoptotic neurons ([41.93±7.49]% vs. [30.59±8.60]%) in mice of the TBI+IFX group were significantly deceased ( P<0.05). Three d after modeling, immunofluorescent double labeling showed that the relative caspase-3 expression in the TBI+IFX group (0.76±0.16) was significantly decreased as compared with the TBI group (1.11±0.23, P<0.05). Immunohistochemical staining and ELISA results showed that as compared with those in the TBI group, the Iba-1 staining scores, TNF-α, IL-1β, IL6 and IFN-γ levels, and ROS and RNS contents in TBI+IFX group were significantly decreased ( P<0.05). Immunofluorescent staining and Western blotting showed that as compared with the TBI group, the TBI+IFX group had significantly decreased expressions of NF-κB p65, iNOS and phosphorylated nuclear factor-κB inhibitor-α, and statistically inhibited nuclear translocation of NF-κB ( P<0.05). Conclusion:IFX can reduce inflammatory response and oxidative stress response, and play a neuroprotective role, which is related to its inhibition of downstream NF-κB/iNOS pathway activation.

Surgery via sylvian fissure-insular approach for 8 patients with invasive thalamus cavernous malformations / 中华神经医学杂志

Objective:To investigate the surgical treatment efficacy and experience of invasive thalamus cavernous malformations (CMs).Methods:A retrospective analysis was performed. The clinical and follow-up data of 8 patients with invasive thalamus CMs, admitted to our hospital from July 2007 to June 2020, were chosen. These patients accepted minimally invasive resection via sylvian fissure-insular approach after the second rapture hemorrhage; follow up was performed for 8 months-10 years. Results:The lesions of these 8 patients were near the lateral thalamus, and the lesions were completely removed during the surgery. Within 24 h of surgery, the lower limb muscle strength of one patient was improved to grading 2, and that of 2 patients was improved to grading 1. Follow up results 6 months after treatment showed that the modified Rankin scale scores were 1-3 in 5 patients and 4 in 3 patients; and there were no recurrence during the follow-up of (49.7±37.8) months.Conclusion:The resection via sylvian fissure-insular approach is safe and effective for patients with invasive thalamus CMs after the second rapture hemorrhage.

Analyses of the changes of sphenoid sinus and related factors of sphenoid sinusitis after microscopic transsphenoidal pituitary adenoma resection / 肿瘤研究与临床

Objective:To investigate the changes of sphenoid sinus and related risk factors of sphenoid sinusitis after microscopic transsphenoidal pituitary adenoma resection.Methods:The clinical and imaging data of 106 patients with large pituitary adenoma in 900 Hospital of the PLA Joint Logistics Team between August 2012 and March 2015 were continually collected. The changes of accumulated blood and fluid, inflammation, mucocele, mucosa remodeling in sphenoid sinus cavity at preoperative and postoperative different time points were observed through the analysis of magnetic resonance imaging (MRI). Binary logistic multiple factors regression model was used to analyze the independent risk factors for postoperative sphenoid sinusitis.Results:MRI results showed that the blood and fluid accumulated in sphenoid sinus cavity were absorbed and dissipated 3 months after the surgery, and the saddle bone windows were covered by new mucous membrane at this time, but they were not complete; the remaining tumors in the saddle all sank into the saddle to different degrees. The reconstruction of sphenoid sinus mucosa was basically complete 6 months after the surgery. There were 7 (6.6%) cases of mucocele in sphenoid sinus and 26 (24.5%) cases of sphenoid sinusitis 3 months after the surgery among 106 patients. The results of multivariate analysis showed that growth hormone adenoma ( OR = 2.981, 95% CI 1.480-26.207, P = 0.014), preoperative sphenoid sinusitis ( OR = 12.392, 95% CI 2.927-52.462, P = 0.001), frequency of multiple transsphenoidal surgery ( OR = 14.758, 95% CI 2.431-89.584, P = 0.003) and perioperative cerebrospinal fluid leakage ( OR = 11.644, 95% CI 2.175-62.344, P = 0.004) were independent risk factors for postoperative sphenoid sinusitis. Conclusions:The evolution of sphenoid sinus cavity contents has its own rules after microscopic transsphenoidal pituitary adenoma resection. Patients with growth-hormone pituitary adenoma, sinusitis before surgery, multiple transsphenoidal surgery and cerebrospinal fluid leakage during the surgery should receive enhanced anti-infection treatment and nasal care in perioperative period to reduce the possibility of sphenoid sinusitis after surgery. The staged time of reoperation for pituitary adenoma resection by transsphenoidal approach should be about 3 months after the previous operation.

Value of inferior petrosal sinus digital substraction angiography analysis in endovascular treatment of carotid cavernous fistulas / 中华神经医学杂志

Objective:To analyze the digital substraction angiography (DSA) features of inferior petrosal sinus (IPS) in patients with carotid cavernous fistulas (CCF), and explore its guiding value in endovascular treatment of CCF.Methods:The surgical process and whole brain DSA images of 76 CCF patients accepted endovascular treatment in our hospital from January 2013 to December 2019 were retrospectively analyzed. These patients were divided into direct CCF group ( n=52) and indirect CCF group ( n=24) according to the Barrow typing. The development of IPS in the affected side of the 2 groups was compared, and the location of IPS entry into the internal jugular vein (IJV) in patients from direct CCF group and indirect CCF group during the whole process of IPS development was compared, and the efficacy of endovascular treatment of CCF by IPS was analyzed. Results:Indirect CCF group had significantly higher proportion of patients with poor visualization (45.8%, 11/24) as compared with direct CCF group (17.3%, 9/52, P<0.05). Except one patient with IPS not connecting to IJV, the proportion of intracranial IPS-IJV junction showed no significant difference between the two groups ( P>0.05). IPS embolization was the first choice for all the 24 indirect CCF patients: 13 patients with IPS whole-process development had a relatively smooth superselecative cathelerization (reperfusion rate=100%), and the time of microcatheter placement was relatively short (32 min on average); in the 11 patients with poor IPS development, 5 were successfully opened by loach guidewire guidance and microguide wire looping technique (reperfusion rate=45%), and microcatheter placement was relatively long (69 min on average). Conclusions:Indirect CCF has a high rate of IPS occlusion. Lateral and 3D images show that IPS is parallel to the petrous bone segment of internal carotid artery. Mastering the course of IPS and the location of its terminal into IJV has very important value for guiding the microcatheter to enter the cavernous sinus through the poorly visualized IPS.

Clinical value of ventricular intracranial pressure monitoring in gradient decompression for patients with traumatic cerebral hernia / 中华神经医学杂志

Objective:To investigate the clinical value of ventricular intracranial pressure monitoring (V-ICPM) in gradient decompression for patients with traumatic cerebral hernia.Methods:The clinical data of 103 patients with traumatic cerebral hernia admitted to our hospital from October 2016 to October 2020 were retrospectively analyzed. These patients were divided into observation group ( n=49) and control group ( n=54) according to whether V-ICPM was applied. Patients in the observation group accepted V-ICPM before gradient decompression, and patients in the control group accepted gradient decompression directly. Incidence of malignant encephalocele, clinical short-term and long-term efficacies, and complications were compared between the two groups. According to intracranial pressure (ICP), the patients were divided into normal or slightly increased ICP (≤22 mmHg), moderate increased ICP (23-40 mmHg) and severe increased ICP (>40 mmHg); the relationship between ICP and prognoses was analyzed in the observation group. Results:(1) The incidences of intraoperative malignant encephalocele in the observation group (16.33%) were slightly lower than that in the control group (29.63%), without significant difference ( P>0.05). Twenty four h after gradient decompression, pupils recovered in 35 patients (71.43%) from the observation group and 28 patients (51.85%) from the control group, significant difference in the pupils recovery rate was noted between the two groups ( χ2=4.145, P=0.042); the Glasgow Coma Scale (GCS) scores between the observation group (8.43±2.56) and control group (7.39±2.47) showed statistical differences ( t=-2.095, P=0.039). Three months after gradient decompression, there were 7 patients with Glasgow Outcome Scale (GOS) scores of 5, 18 patients with scores of 4, 10 patients with scores of 3, 8 patients with scores of 2, and 6 patients with score of 1 in the observation group; there were 12 patients with GOS scores of 5, 17 patients with scores of 4, 12 patients with scores of 3, 7 patients with scores of 2, and 6 patients with score of 1 in the control group; the difference was not statistically significant ( Z=-0.681, P=0.496). (2) The higher the ICP in the observation group (initially and when the dura mater is cut), the worse the prognosis. Conclusion:The application of V-ICPM before gradient decompression cannot further improve the long-term prognosis of the patients, but it can provide intraoperative reference and prognosis prediction for the operators.

Recent advance in diagnosis and treatment of cerebral venous sinus thrombosis / 中华神经医学杂志

Cerebral venous sinus thrombosis (CVST) is a relatively rare cerebrovascular disease. In recent years, in order to further deepen the understanding of the disease, reduce the missed diagnosis rate and misdiagnosis rate, and improve the curative effect, a series of studies on the diagnosis and treatment strategies of CVST have been carried out at home and abroad. It is found that some new imaging technologies can improve the early diagnosis rate of the disease, and some new drugs have emerged to treat the disease. In order to help clinical colleagues to further improve their understanding, this paper briefly reviews this.

Recent advance in metabolomics of pituitary adenoma / 中华神经医学杂志

Metabolomics analyzes the physiological or pathological states of an organism by evaluating small molecules in various biological fluids or tissues. The early diagnosis, differentiation and evaluation of pituitary adenoma are difficult and lack of special biological markers. In recent years, in order to search for specific biological markers and their molecular biological mechanisms, many scholars have applied a variety of metabolomics analysis techniques to study the metabolites in the pathological tissues of pituitary adenoma and the serum, urine and other biological fluids of the patients. This paper reviews the progress and achievements of metabolomics in pituitary adenoma.

Correlation of pericyte-mediated cerebral microcirculation disturbance with central nervous system diseases / 中华神经医学杂志

Pericytes are a kind of microvascular parietal cells, which constitute neurovascular units together with neurons, astrocytes, microglia, vascular endothelial cells and vascular smooth muscle cells to maintain the basic function of the brain. Pericyte dysfunction can lead to cerebral microcirculation dysfunction, which is related to the occurrence and development of a variety of nervous system diseases. This article reviews the characteristics, identification and subtypes of pericytes, their relations with cerebral microcirculation, and their correlation with central nervous system diseases.

Clipping posterior communicating artery aneurysms of medial posterior inferior type by conventional pterional craniotomy: a clinical observation study / 中华神经医学杂志

Objective:To investigate the clipping methods of ruptured posterior communicating artery (PCoA) aneurysms of medial posterior inferior type (aneurysms located at the medial posterior inferior part of internal carotid artery or occluded by the internal carotid artery) during conventional pterional craniotomy.Methods:Seven patients with ruptured PCoA aneurysms, admitted to our hospital from January 2004 to January 2020, were chosen in our study. The clinical data and surgical efficacies of these patients were retrospectively analyzed.Results:The anterior choroidal artery (AChA) was accidentally clipped in 2 patients during the surgery, of which one was released after adjustment and one was avoided after multiple adjustments. Due to severe acute brain swelling, the brain tissues of the anterior temporal lobe were removed for about 20 mm in 2 patients, and the anterior temporal lobe was retracted posteriorly by platens in 5 patients. All aneurysms disappeared in the postoperative CTA images, no residual neck was found, and the parent artery remained unobstructed. One patient had cerebral infarction in the AChA supplying area. All patients were followed up for 1-6 years, with an average of 27.6 months. Six patients recovered completely without neurological dysfunction. One patient had contralateral hemiplegia, with muscle strength grading III, walking on crutches, and basic living by himself.Conclusion:It's difficult to clip the ruptured PCoA aneurysms of medial posterior inferior type by conventional pterional craniotomy; so straight and curved aneurysm clips can be used to clip aneurysms by expanding the inter-cisternal space around the aneurysms.

Recent advance in interaction between acute subdural hematoma and disorder of intracranial superficial venous circulation / 中华神经医学杂志

Traumatic acute subdural hematoma (ASDH) is often severe,and bridging vein rupture is one of the case mechanisms of ASDH.After traumatic ASDH,venous reflux disorder,cerebral ischemia,delayed bleeding in other parts of the brain,and intraoperative encephalocele are prone to occur.This article reviews the occurrence and development of ASDH and its relation with intracranial venous circulation.