BACKGROUND:This paper analyzed the cases of dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) in the diagnosis and treatment process.CASE PRESENTATION:One case involving dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) from the 306th Hospital of PLA was retrospectively analyzed. The patient consulted the doctor due to lower limb sensory and motor disorders while exhibiting symptoms of urinary dysfunction. A computed tomographic angiography (CTA) and cerebral angiography confirmed the diagnosis of dural arteriovenous fistula (DAVF), necessitating surgical treatment. The patient was referred to our hospital for an magnetic resonance imaging (MRI) and a spinal angiography to obtain a confirmed diagnosis for spinal arteriovenous fistula, after which they underwent surgical fistula resection. The invasive intracranial dural arteriovenous fistula (DAVF) resection proceeded smoothly but did not ease the patient's symptoms. However, postoperative symptoms were partially relieved by the lumbar open spinal dural arteriovenous fistula adminstration.CONCLUSIONS:Since not enough is understood about these two diseases, the rate of misdiagnosis is significantly increased. Early diagnosis and treatment of spinal dural arteriovenous fistula (SDAVF) can play a positive role during the recovery from neural function damage.

目的 观察海马横切术与立体定向海马杏仁复合体射频热凝术对顽固性颞叶内侧型癫痫患者的治疗效果及其对认知和记忆功能的影响.方法 对12例海马横切术和15例立体定向海马杏仁复合体射频热凝术的癫痫控制率以及手术前后神经心理学检查(包括韦氏智力检查:言语智商VIQ、操作智商PIQ、总智商FIQ和记忆商MQ)结果进行统计分析.结果 两组患者术后癫痫控制有效率均可达80％以上,海马横切术的无发作率为66.67％,立体定向海马杏仁复合体射频热凝术组为40％,尚未达到明显统计学差异(P＞0.05).两组手术前后神经心理学检查结果均无显著差异(P＞0.05).结论 海马横切术与立体定向海马杏仁复合体射频热凝术治疗顽固性颞叶内侧型癫痫均有效,且对患者认知及记忆等神经功能均无明显损害;海马横切术在癫痫控制方面有明显优势,是一种值得提倡和推广的手术方法,虽然立体定向手术的癫痫发作消失率较低,但并未达到统计学差异,且其微创的特性仍倍受广大颞叶内侧型癫痫患者的青睐.

OBJECTIVE:To verify the minimally invasive surgical approach and therapeutic effects of using the medical neurosurgery robot Remebot to treat hypertensive intracerebral hemorrhage (HICH).METHODS:Clinical data for 17 HICH patients were analyzed retrospectively. Hematoma evacuation and tube drainage using Remebot frameless stereotaxic techniques were performed for all patients, and urokinase was injected into the hematomas after the operations.RESULTS:Robot-assisted stereotactic techniques can accurately guide hematoma punctures, and no deaths occurred among these patients. The average positioning error was 1.28 ± 0.49 mm. The average drainage duration was 3.4 days. The 3-month postoperative follow-up revealed improved neurological functions and quality of life for all patients.CONCLUSIONS:The medical neurosurgery robot Remebot is minimally invasive, has high positional accuracy, and facilitates surgical planning according to the shape of the hematoma. Therefore, robot-assisted surgery using Remebot represents a safe and effective treatment method for hematoma evacuation and tube drainage in HICH patients.

目的:通过改进原代培养方法,从大面积脑梗塞患者废弃脑组织中培养、传代和鉴定自体神经干细胞(NSCs),并进行诱导分化研究.方法:收集2例右侧大面积脑梗塞患者手术中废弃脑组织各1 g以上,按改良方法进行原代培养并传代,通过细胞免疫荧光染色检测NSCs标志物巢蛋白(nestin)的表达.传代培养至7代时选取部分细胞进行诱导分化研究,通过细胞免疫荧光染色检测胶质纤维酸性蛋白(GFAP)和微管蛋白(β-tu-bulin)的表达来评估NSCs分化情况.结果:培养3～7d后,2例患者废弃脑组织中均可见干细胞球生长,nestin检测呈阳性表达.经传代培养至第10代后,仍可维持其神经干细胞特征,选取7代贴壁细胞经β-Tubulin及GFAP免疫荧光检测可见阳性表达.结论:成功从大面积脑梗塞患者前颞叶(邻近于海马区)废弃脑组织中分离培养获得自体NSCs,并可向神经元样细胞及星形胶质样细胞分化.

目的探讨前外侧腹膜后入路切除椎管内外沟通性巨大哑铃型肿瘤的诊疗经验.方法回顾性分析采用前外侧腹膜后入路一期手术切除的1例腰椎管巨大哑铃型肿瘤的临床资料.先由骨科医生根据C型臂透视定位,从左侧12肋后部向脐行倒八字切口手术,显露肿瘤的椎管外部分并切除;然后,由神经外科医生在显微镜下将椎管内肿瘤切除.结果术后MRI检查示肿瘤完全切除.术后病理证实为神经鞘瘤.术后3个月随访,恢复良好,术前症状完全消失;复查MRI示椎管内无强化影像.结论多学科联合,前外侧腹膜后入路一期手术切除腰椎椎管内外沟通性巨大哑铃型良性肿瘤,可取得较好的效果.

Objective:To provide the preclinical platform for stereotactic autologous neural stem cells(NSCs)transplantation to treat the sequela of encephalorrhagia,cerebral infarction and craniocerebral injury.Methods:The abandoned brain tissues from different areas were collected during open cranial surgery.Above 500 mg abandoned brain tissues in each case were primarily cultured by the modified methods and handed from generation to generation.The expression of Nestin(the marker of NSCs)was detected by immunofluorescence cytochemistry.The induced differentiation began from the 5th generation.Results:About 3 to 10 days after inoculation,stem cells sphere growth was observed in most cases.All the stem cell spheres were positive for Nestin.The 6th generation cells were collected for immunofluorescence cytochemistry with β-Tubulin(the marker of neuron),Sox10(the marker of oligodendrocyte)and GFAP(the marker of astrocyte)respectively,in which a few of the adherent cells were found to be positive as neurons,oligodendrocytes and astrocytes.The Western blotting was performed to 3rd and 6th generation cells.In 3th generation,only Nestin and a few of β-Tubulin were positive.However,in the 6th generation,the Nestin,Sox10,β-Tubulin and GFAP were all found positive on different levels.Conclusion:This study successfully obtains adult NSCs from the abandoned brain tissues in different regions during open cranial surgery and the autologous NSCs could be differentiated into neurons and gliocytes.It is possible for stereotactic autologous NSCs transplantation to repair the neural function from laboratory to clinical applications.

目的 探讨脊柱侧弯伴发脊髓拴系综合征患者行脊髓拴系松解手术的治疗要点和临床疗效.方法 回顾性分析2000年4月至2018年12月收治的282例脊柱侧弯伴发脊髓拴系综合征患者的临床资料,并对其临床表现、术前诊断和手术要点进行探讨,根据Hoffman功能分级、Kirollos松解分级、神经电生理结果评估手术疗效.结果 280例患者在显微镜辅助下行终丝切断术联合拴系松解术,均取得良好效果,未发生脊髓及神经严重损伤等并发症.187例患者随访12～36个月,中位随访时间17.6个月,患者临床症状和神经功能均有不同程度的改善和好转.结论 终丝切断及粘连松解术是治疗脊髓拴系综合征的唯一手段,对于生长发育期的青少年和行脊柱矫形术会使脊柱纵向延长的患者尤为重要,可为下一步脊柱侧弯矫形手术打下良好基础.术前腰骶椎CT三维重建、MRI检查、术中神经电生理监测的使用可以提供有价值的诊断信息并提高手术的安全性.

目的 测量睿米神经外科医疗机器人辅助下行无框架立体定向手术的精度.方法 回顾性分析26例在睿米神经外科医疗机器人引导下行无框架立体定向手术的病例资料,其中活检术10例,电极植入及(癎)灶毁损术9例,血肿置管引流术7例.根据穿刺器械刚性程度分为活检毁损组(靶点14个)、电极植入组(靶点13个)与置管引流组(靶点9个).通过术前计划影像资料与术后影像资料融合,测量实际靶点与规划靶点之间的三维空间距离.结果 活检毁损组精度误差为(1.330±0.566)mm,电极植入组精度误差(2.404±0.878)mm,置管引流组(6.188±4.103)mm.与电极植入组以及置管引流组比较,活检毁损组精度误差较小,差异均具有统计学意义(均P<0.05);电极植入组与置管引流组比较,差异无统计学意义(P>0.05).结论 电极与引流管均为软性材质,入颅后漂移移位导致定位误差增大.活检针与毁损电极均为刚性材质,不易移位,可真实反映睿米定位精度.

Objective To observe the outcomes of seizure control by three different surgical approaches,hippocampal transection,anterior temporal lobectomy and selective amygdalo-hippocampectomy,for the treatment of intractable medial temporal epilepsy,and explore their influences in the impairments of cognitive and memorial functions.Methods Twenty-nine patients with intractable medial temporal epilepsy,admitted to our hospital from January 2012 to October 2015,were chosen in our study;8 patients accepted hippocampal transection,10 accepted anterior temporal lobectomy and 11 accepted selective amygdalo-hippocampectomy.Seizure controls after treatment with these 3 approaches were compared and results of neuropsychological examinations (verbal intelligence quotient [VIQ],performance intelligence quotient [PIQ],full intelligence quotient [FIQ] and memory quotient [MQ]) were compared before and after operation.Results The effective rates of seizure controls were all higher than 80％ and seizure free rate was about 60％ in the 3 groups;Engel grading showed no significant differences among the three groups (P＞0.05).Results of all the neuropsychological examinations in the hippocampal transection group before and after operation had no significant differences (P＞0.05);however,all results in the anterior temporal lobectomy group after operation were significantly declined as compared with those before operation (P＜0.05);and PIQ,FIQ and MQ scores in the selective amygdalo-hippocampectomy group after operation were significantly lower as compared with those before operation (P＜0.05).Conclusions Hippocampal transection will not cause significant damage in intelligence and memory functions.As compared with both anterior temporal lobectomy and selective amygdalo-hippocampectomy,hippocampal transection can have good seizure control and preserve memory function.

Objective To investigate the effect of blocking hairy and enhancer of split 1 (Hes1) on gamma aminobutyric acid (GABA) neurons' differentiation in human neural stem cells.Methods The human neural stem cells were cultured for 10 days and identified by nestin immunofluorescence stain,then using the human neural stem cells to differentiate GABA neurons.The design project of experiment was adopted completely random.The control cultured medium were the common differentiated medium added 10％ bovine serum albumin.And the experimental cultured mediums were identical with the control excepted for the anti-Hes1.Anti-GABA immunofluorescence stain was carried out when most of the cells were differentiated.Results A lot of 150-200 μm diameter neurosphere which were identified when cultured for 10 days.The second generation of neurospheres were using for GABA neurons differentiation.At the sixth day,more than half of cells were differentiated and begin to concentrate.Digested and inoculated again,then 90％-95％ cells were adherent and differentiated at day 14.Anti-GABA immuno-fluorescence stain showed that 55-70 positive cells were be found in 100 cells in every visual field,the rate was (64.0 ± 0.6)％ in anti-Hes1 differentiated group and in the same condition the positive cells were only 15-20 positive cells,the rat was (16.6 ± 0.6)％ in control group,there are significant difference between the two groups.Conclusion blocking Hes1 can significant increase the differentiation rate of GABA neurons in human neural stem cells.

目的 探讨穿刺术治疗自发性小脑半球出血的方法及效果.方法 回顾性分析2009年10月至2015年12月应用穿刺术治疗的32例自发性小脑半球出血的临床资料.结果32例均未出现术中出血或术后血肿复发,没有死亡病例.术后血肿腔持续引流时间为2~6 d,平均为3.8 d.拔除穿刺针前均常规复查头颅CT,结果 证实血肿清除率60%~80%,占位效应消失或显著减轻.术后随访6个月,按GOS评分评估预后,恢复良好16例,中残12例,重残4例.结论 对于自发性小脑半球出血,可以采取穿刺术治疗,安全有效,操作简单,尤其适宜年龄较大、病情危重不适合开颅的病人.

Objective To determine the clinical outcomes of a Meige syndrome patient undergoing deep brain stimulation (DBS) with domestic stimulator and bilateral different frequency stimulation program. Methods The clinical data of 1 patient with Meige syndrome undergoing bilateral globus pallidus internus (Gpi) DBS operation was analyzed retrospectively. The routine stimulation was performed 1 month after the operation and different frequency stimulation was administrated 3 months postoperatively. Burke-Fahn-Marsden dystonia rating scale (BFMDRS) was used to evaluate the clinical outcome. Results The symptoms of the patient were significantly improved by the stimulation 1 month after the operation. The BFMDRS declined from 22 to 6. Since the right electrode contacts were near the posterior limb of the internal capsule, the voltage of stimulation was low and the patient felt numb of left limbs. The effect was obtained by increasing the voltage of the left electrode. The symptoms recurred a little 3 months after the operation and the BFMDRS was recovered to 10. The different frequency stimulations in the left and right sides were administrated with decrease of the stimulation frequency in the right side. The stimulation voltage in the right side was increased to improve the symptoms and in the left side was decreased in order to reduce the power consumption. The numb of left limbs disappeared and the symptoms further improved. BFMDRS was decreased to 4. Conclusions DBS with domestic stimulator at bilateral Gpi is satisfactory for the treatment ofMeige syndrome and different frequency stimulations in the left and right sides can decrease the side effect and increase the treatment effect further.

背景:对胎儿、胎鼠及成鼠神经干细胞培养已有大量研究,但成体人自体神经干细胞培养相关研究较少。目的:通过改进原代培养方法,从颅内动脉瘤破裂脑出血患者血肿腔周边废弃脑组织中培养和鉴定神经干细胞,并进行冻存与复苏研究,建立成人自体神经干细胞库。方法:收集3例动脉瘤破裂脑出血（2例大脑中动脉瘤及1例前交通动脉瘤）手术中血肿腔周边的废弃脑组织各约500 mg以上,采用细小组织块接种法进行原代无血清悬浮培养成人自体神经干细胞,倒置显微镜下观察细胞生长情况,免疫荧光细胞化学技术检测神经干细胞标志物巢蛋白（Nestin）的表达。培养获得的神经干细胞球以体积分数4%胎牛血清诱导其贴壁生长,待细胞增殖达到一定数量后传代培养。传代后部分细胞予以冻存建库,并复苏继续传代及诱导分化培养。体积分数10%胎牛血清诱导神经干细胞分化,通过免疫荧光细胞化学技术检测胶质纤维酸性蛋白（标记星形胶质样细胞）,β-tubulinⅢ（标记神经元样细胞）,SOX10（标记少突胶质样细胞）蛋白的表达来测定神经干细胞的分化能力。结果与结论:改进培养方法后,3例患者废弃脑组织中,在无血清培养液中均可形成Nestin阳性表达的神经球,并可在体外大量扩增和连续传代。在给予体积分数10%FBS条件下神经球可分化为神经元样细胞、少突胶质细胞及星形胶质细胞,即β-tubulin Ⅲ,SOX10及胶质纤维酸性蛋白阳性表达。经传代培养至5代后,仍呈Nestin阳性即可维持其神经干细胞特征。冻存细胞复苏后生长状态良好且呈Nestin阳性,可继续传代扩增。结果表明,从动脉瘤破裂脑出血患者不同脑区（颞极及额底）血肿腔周边废弃脑组织中可成功培养获得自体神经干细胞,并可向神经元样细胞、少突胶质样细胞及星形胶质样细胞分化,使自体神经干细胞移植促进神经功能修复从实验室到临床应用成为可能。

Objective To observe the seizure control and the effect on cognitive and memory function of hippocampal transection in intractable medial temporal epilepsy patients.Methods Eight cases of hippocampal transection and 10 cases of anterior temporal lobectomy were selected in which were all performed by the same operator.All the patients' basic information(including age,gender,seizure time and so on),preoperative examination(head magnetic resonance imaging,video electroencephalogram),seizure control and neuropsychological examinations (including VIQ:verbal intelligence quotient,PIQ:performance intelligence quotient,FIQ:full intelligence quotient and memory quotient) before and after the operation were collected and analyzed.Results The basic information and preoperative examinations have no significant difference in two groups.The seizure control were all high than 80％ in two groups and there is also no significant difference.All the neuropsychological examinations' scores before operation have no significant difference compared with the that of two weeks after operation in the hippocampal transection group (P＞0.05).However,in the anterior temporal lobectomy group,all scores were significantly declined (P＜0.05).According to the span D-value of the scores before and after operation,the decline of MQ was found with significant difference in two groups (P＜0.05).Conclusion In the meanwhile of seizure control,hippocampal transection will not cause significant damage of intelligence and memory function.Compared with anterior temporal lobectomy,th-e memory function can be preserved well after hippocampal transection.So it is a good surgical approach for intractable medial temporal epilepsy.

Objectives: To investigate the key surgical points in treating split cord malformations associated with osseous divide and scoliosis (SCM-OD-S). Materials and methods: The surgical options and methods of a total of 142 SCM-OD-S cases were retrospectively analyzed, and the surgical precautions and imaging diagnosis were also discussed. Results: The 142 patients were performed osseous divide resection plus dural sac molding, which achieved good results and no serious complication such as spinal cord and nerve injury occurred; certain symptoms such as urination-defecation disorders, muscle strength subsidence, Pes Cavus, and toe movement disorder in partial patients achieved various degrees of relief, and it also created good conditions for next-step treatment against scoliosis. Conclusions: The diagnosis of SCM-OD mainly depended on imaging inspection, routine magnetic resonance imaging (MRI) combined with computed tomography (CT) 3D reconstruction, which can comprehensively evaluate the types and features of diastematomyelia as well as other concomitant diseases. SCM alone needed no treatment, but surgery will be the only means of treating SCM-OD. Intraoperatively removing osseous divide step-by-step, as well as carefully freeing the spinal cord and remodeling the dural sac, can lay good foundations for relieving tethered cord, improving neurological symptoms, and further scoliosis orthomorphia, thus particularly exhibiting importance for the growth and development of adolescents. (c) 2017 Published by Elsevier Sp. z o.o. on behalf of Polish Neurological Society.

Objective To verify the effectiveness and safety of domestic neurosurgery medical robot Remebot for the treatment of hypertensive cerebral hemorrhage (HCH). Methods Clinical data of 3 HCH patients were analyzed retrospectively. Hematoma evacuation and tube drainage with Remebot frameless stereotaxy were performed in all the patients, and urokinase was injected into hematoma after the operation. Two drainage tubes were implanted in 1 patient and 1 drainage tube in 2. Results Hematoma disappeared in 2 patients and significantly reduced in 1 after 2 days of drainage. During a follow-up period of 1 to 2 years, the muscle strength was recovered to grade 4 in 1 patient and grade 5 in 1. While 1 patient was found to have repeated hemorrhage and diagnosed with thrombasthenia, then, platelets were transfused to stop bleeding, and craniotomy was performed for 4 times in this patient and the muscle strength of the left limb was grade 0. Conclusions The domestic neurosurgery medical robot Remebot is minimal invasive and high positional accuracy, and surgical planning can be made according to the shape of hematoma. It must be suitable for hematoma evacuation and tube drainage in HCH patients. For the patient with less hematoma but severe functional disability, hematoma evacuation should be performed as early as possible functional recovery.

Objective To compare the surgical outcome and its influences on cognition and memory of hippocampal transection and selective amygdalohippocampectomy for intractable medial temporal lobe epilepsy. Methods Clinical data of 19 patients with intractable medial temporal lobe epilepsy were analyzed retrospectively, including 8 patients receiving hippocampal transection (observation group) and 11 receiving selective amygdalohippocampectomy (control group). The seizure control rate after surgery and neuropsychological examinations before and after surgery were analyzed and compared. Results There was no significant difference in seizure control rates between two groups (P>0.05). There was no significant difference in performance intelligence quotient (PIQ), verbal intelligence quotient (VIQ), full intelligence quotient (FIQ) and memory quotient (MQ) before and after surgery in observation group (P>0.05). The PIQ, FIQ and MQ after surgery in control group were obviously lower than those before surgery (P<0.05). There was significant difference in MQ differentials before and after surgery between the two groups (P<0.05). Conclusion Hippocampal transection can effectively control seizure, make little damage to the function of neuropsychology and especially can well preserve the memory function.

Objective To verify the effectiveness and safety of domestic neurosurgery medical robot Remebot for the biopsy of intracranial lesions.Methods Thirteen patients with intracranial lesions having comparatively difficulty in diagnosis in our hospital from January 2016 to May 2016 were randomly selected to robot operation group (n=6) and frame stereotactic group (n=7).In the robot operation group,four marks were pasted to the patient's head for the stereotaxy without frame,while in the frame stereotactic group,the frame should be fixed to the patient's head for the operation.The targets were set at the central of the lesions and the biopsies were performed through targets to the whole lesions.The specimens were sent for pathologic examinations with immunohistochemical staining.Results The confirmed diagnostic rate of robot operation group was 6/6:glioblastoma multiforme in 3,oligodendroglioma in one,non-Hodgkin's lymphoma in one and focal cortical dysplasia in one;the confirmed diagnostic rate of the frame stereotactic group was 6/7:glioblastoma multiforme in 2,grade Ⅱ-Ⅲ astrocytoma in 2,follicular thyroid carcinoma in one and cerebellum ganglion glioma in one,and the one without confirmed diagnosis was intracranial multiple cystic lesion.The positional accuracy in the robot operation group was 1.48±0.62 (accuracy error:0.66-2.47 mm) and that in the frame stereotactic group was 1.06±0.49 (accuracy error:0.50 mm-l.90 mm).Conclusions The domestic neurosuregery medical robot Remebot is characteristic by minimal invasive and high positional accuracy.It is quite suitable for frameless stereotactic intracranial lesion biopsy.The surgical planning could be made according to the shape of lesions and the positional accuracy is reached to the requirement of biopsy.Since the procedure of operation could be performed without fixing the frame on patients' head,the pain and fear of patients are reduced in a great deal and the operation is quite easy to be performed.Thus,it's more suitable for the biopsy ofintracranial lesions.

Objective To evaluate the surgical procedure and clinical value for hypertensive intracerebral hemorrhage (HICH) with frameless stereotactic Technique.Methods 17 cases of HICH were treated with frameless Stereotactic instrument and using minimal invasive puncture needle to smash and drain the hematoma.Treatment outcome,mortality rate as well as long-term prognosis (ADL score) were analyzed retrospectively.Results Using frameless Stereotactic instrument can accurately guide the completion of intracerebral hemorrhage puncture and no mortality during the follow-up period.The average drainage time was 3.4 days.The head CT scans before the needle extraction suggested hematoma clearance range was about 70％ ～900 with the space occupying effect significantly reduced.The neural function and long-term quality of life were improved after 3 month post surgery.Conclusion Frameless stereotactic hematoma aspiration is a timely,safety and effective treatment method that can be well applied to some HICH patients,getting a better improving of nerve function better and prognosis.Especially,it could be recommended for patients with advanced age or deep bleeding site that are not suitable for craniotomy,expanding the range of indications for surgery.

Objective The surgery and therapy of diastematomyelia with osseous divide and scoliosis were discussed.Methods Surgical choice,operative methods,the direction to the surgery and imaging diagnosis of 142 cases of diastematomyelia patients with osseous divide and scoliosis were reviewed.Results All patients achieved a satisfactory result by osseous divide resection and lumbosacral dural sac plasty,which provided a good basis for the further scoliosis instrmentation.Primary nerve damage symptoms were lightened or eliminated in some patients.Conclusion Before surgical instrumentation,all scoliosis patients should be performed spinal X-ray,CT and MRI examination to detect the diastematomyelia and osseous divide.The combination of CT and MRI imaging can be helpful for determining the types of diastematomelia and associated malformation,and can provide more diagnostic value for operation.Sole diastematomyelia does not need any treatment.Patients with diastematomyelia and osseous divide should accept osseous divide resection and lumbosacral dural sac plasty before spinal instmmentation operation,which is very important for young patients in period of growth.