Cerebral Cavernous Malformations (CCMs) are vascular anomalies in the central nervous system that arise from both genetic and non-genetic factors, and can cause hemorrhage, seizures, and neurological deficits. Approximately 80% of CCMs are sporadic, while 20% are Familial (FCCMs), an autosomal dominant, monogenic disorder characterized by multiple lesions and severe clinical manifestations. Over the past three decades, linkage analyses have identified KRIT1/CCM1, MGC4607/CCM2, and PDCD10/CCM3 as major pathogenic genes in FCCMs. However, existing surgical and pharmacological treatments have not adequately prevented disease progression, underscoring the need for more effective strategies. Recent advancements in gene editing tools and delivery systems have transformed gene therapy from a laboratory concept to a clinical reality, offering renewed hope for FCCM patients. Given the multifactorial nature, complexity, and neurological comorbidities of FCCMs, exploring non-surgical gene therapies provides a promising approach for addressing these cerebrovascular lesions. This review summarizes the latest progress in gene editing for FCCMs and examines its therapeutic potential, while acknowledging both the promising benefits and the remaining uncertainties in this evolving field.

OBJECTIVE:To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. METHODS:From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. RESULTS:Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. CONCLUSION:Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.

OBJECTIVE:To explore the application and key points of microchannel approaches in resection of cervical intraspinal tumors.METHODS:A retrospective analysis was performed on 51 cases of cervical spinal canal tumors from February 2017 to March 2020. Among them, 5 cases were located epidural space, 6 cases were located epidural and subdural space, and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord). The maximum diameter ranged from 0.5 to 3.0 cm. The clinical manifestations included neck, shoulder or upper limb pain 43 cases, sensory disturbance (numbness) in 22 cases, and limb weakness in 8 cases. The microchannel keyhole technique was used to expose the tumor, and the tumor was resected microscopically.RESULTS:In this study, 35 patients underwent hemilaminectomy, 12 patients underwent interlaminar fenestration, 2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration. Two tumors were resected through anatomy space (no bone was resected). The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case. The type of the tumor included 36 schwannomas, 12 meningiomas, 2 enterogenic cysts and 1 dermoid cyst. There was no infection and cerebrospinal fluid leakage postoperatively. Limb numbness occurred in 7 patients. The average follow-up time was 15 months (3 to 36 months). No deformity such as cervical instability or kyphosis was found. The tumor had no recurrence.CONCLUSION:The cervical spinal canal is relatively wide, cervical tumors with no more than three segments can be fully exposed by means of microchannel technology. Besides intramedullary or malignant tumors, they can be microsurgically removed. Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine. The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.

BackgroundGliomas, originating from the most common non-neuronal cells in the brain (glial cells), are the most common brain tumors and are associated with high mortality and poor prognosis. Glioma cells exhibit a tendency to disrupt normal cell-cycle regulation, leading to abnormal proliferation and malignant growth. This study investigated the predictive potential of GJC1 in gliomas and explored its relationship with the cell cycle.MethodsRetrospective analysis of RNA-seq and single-cell sequencing data was conducted using the Chinese Glioma Genome Atlas (CGGA) and The Cancer Genome Atlas (TCGA) databases. The differential expression of GJC1 in gliomas with various pathological features and in different non-neuronal cell groups was analyzed. Functional data were examined using gene set variation analysis (GSVA). Furthermore, CellMiner was used to evaluate the relationship between GJC1 expression and predicted treatment response across these databases.ResultsGJC1 expression was enriched in high-grade gliomas and 1p/19q non-codeletion gliomas. GJC1 enrichment was observed in classical and mesenchymal subtypes within the TCGA glioma subtype group. In single-cell subgroup analysis, GJC1 expression was higher in glioma tissues compared to other non-neuronal cells. Additionally, the TCGA classical subtype of glioma cells exhibited more GJC1 expression than the other subgroups. GJC1 emerged as an independent prognostic factor for overall survival in glioma. GSVA unveiled potential mechanisms by which GJC1 may impact cell-cycle regulation in glioma. Finally, a significant correlation was observed between GJC1 expression and the sensitivity of multiple anti-cancer drugs.ConclusionThese findings confirmed GJC1 as a novel biomarker and provided insights into the differential gene expression in non-neuronal cells and the impact of the cell cycle on gliomas. Consequently, GJC1 may be used to predict glioma prognosis and has potential therapeutic value.

In tumor therapeutics, the transition from conventional cytotoxic drugs to targeted molecular therapies, such as those targeting receptor tyrosine kinases, has been pivotal. Despite this progress, the clinical outcomes have remained modest, with glioblastoma patients' median survival stagnating at less than 15 months. This underscores the urgent need for more specialized treatment strategies. Our review delves into the progression toward immunomodulation in glioma treatment. We dissect critical discoveries in immunotherapy, such as spotlighting the instrumental role of tumor-associated macrophages, which account for approximately half of the immune cells in the glioma microenvironment, and myeloid-derived suppressor cells. The complex interplay between tumor cells and the immune microenvironment has been explored, revealing novel therapeutic targets. The uniqueness of our review is its exhaustive approach, synthesizing current research to elucidate the intricate roles of various molecules and receptors within the glioma microenvironment. This comprehensive synthesis not only maps the current landscape but also provides a blueprint for refining immunotherapy for glioma, signifying a paradigm shift toward leveraging immune mechanisms for improved patient prognosis.

Background— Postoperative delirium is a common complication associated with the elderly, causing increased morbidity and prolonged hospital stay. However, its risk factors in chronic subdural hematoma patients have not been well studied. Methods— A total of 202 consecutive patients with chronic subdural hematoma at Peking University Third Hospital between January 2018 and January 2023 were enrolled. Various clinical indicators were analyzed to identify independent risk factors for postoperative delirium using univariate and multivariate regression analyses. Delirium risk prediction models were developed as a nomogram and a Markov chain. Results— Out of the 202 patients (age, 71 (IQR, 18); female-to-male ratio, 1:2.7) studied, 63 (31.2

BACKGROUND:Surgical treatment remains the mainstream therapeutic regimen for chronic subdural hematoma (CSDH), and burr-hole craniostomy with subdural drainage is the preferable approach. Herein, we reported a case of intracranial granuloma formation as a late complication of burr-hole surgery for CSDH.CASE PRESENTATION:A 31-year-old man presented with a 1-month history of headache. Head computed tomography (CT) showed a subdural hematoma in the left frontal-temporal-parietal region with significant midline shifting. A burr-hole evacuation of the hematoma with closed-system drainage was performed. CT obtained immediately after the surgery demonstrated that the hematoma was mostly evacuated. Nine months later, he presented to us again due to intermittent headache in the left temporoparietal region. Brain magnetic resonance imaging revealed a space-occupying mass at the site of the original hematoma. A bone-flap craniotomy was performed for resecting the mass. Histopathological examination revealed a granuloma. The microbial cultivation of the resected specimen was negative. The postoperative course was uneventful, and the headache was relieved.CONCLUSION:Granuloma formation is an extremely rare late complication of burr-hole surgery for CSDH. Physicians involved in the perioperative management of CSDH should be aware of this condition, and bone-flap craniotomy may be warranted.

Objective:Spinal meningeal cysts (SMCs) are currently classified into three types: extradural cysts without nerve root fibers (Type I), extradural cysts with nerve root fibers (Type II), and intradural cysts (Type III). However, the sacral terminal filar cyst is a distinct subtype with the filum terminale rather than nerve roots within the cyst. This study aimed to investigate the clinicoradiological characteristics and surgical outcomes of sacral terminal filar cysts.Methods:A total of 32 patients with sacral terminal filar cysts were enrolled. Clinical and radiological profiles were collected. All patients were surgically treated, and preoperative and follow-up neurological functions were evaluated.Results:Chronic lumbosacral pain and sphincter dysfunctions were the most common symptoms. On MRI, the filum terminale could be identified within the cyst in all cases, and low-lying conus medullaris was found in 23 (71.9%) cases. The filum terminale was dissociated and cut off in all cases, and the cyst wall was completely resected in 23 (71.9%) cases. After a median follow-up period of 26.5 ± 15.5 months, the pain and sphincter dysfunctions were significantly improved (both P < 0.0001). The cyst recurrence was noted in only 1 (3.1%) case.Conclusions:Sacral terminal filar cysts are rare, representing a distinct variant of SMCs. Typical MRI features, including filum terminale within the cyst and low-lying conus medullaris, may suggest the diagnosis. Although the optimal surgical strategy remains unclear, we recommend a combination of resection of the cyst wall and dissociation of the filum terminale. The clinical outcomes can be favorable.

目的 探讨多模态神经导航在经鼻蝶垂体腺瘤切除手术中的应用效果.方法 回顾性分析2019年6月至2022年5月北京大学第三医院神经外科采用神经导航下经鼻蝶入路肿瘤切除术治疗的138例垂体腺瘤患者(导航组)的临床资料,以2018年1月至2019年5月采用经鼻蝶入路肿瘤切除术治疗的48例垂体腺瘤患者作为对照组.两组患者的年龄、性别等基线资料的差异均无统计学意义(均P＞0.05).对比分析两组患者的疗效及并发症发生率等.结果 与对照组比较,导航组蝶窦开口识别率[分别为100％(138/138)、91.7％(44/48)]、视神经沟和颈动脉压迹识别率[分别为 100％(138/138)、83.3％(40/48)]均更高,手术时间更短[分别为(67.0±13.2)min、(85.6± 18.2)min],术中出血量更少[M(Q1,Q3)分别为15(15,20)ml、30(15,40)ml],差异均具有统计学意义(均P＜0.05).导航组与对照组术后脑脊液漏[分别为2.9％(4/138)、6.3％(3/48)]、短暂性尿崩[分别为4.3％(6/138)、8.3％(4/48)]发生率的差异均无统计学意义(均P＞0.05).导航组与对照组患者肿瘤全切除率的差异无统计学意义[分别为93.5％(129/138)、87.5％(42/48),x2=1.72,P=0.190].所有患者均获得临床随访,导航组的随访时间较对照组短[(10.1±5.6)个月、(22.6± 6.9)个月,t=-12.55,P＜0.001].随访期间,两组患者的临床症状均有不同程度的改善,且无激素水平低下者;导航组与对照组患者肿瘤复发率的差异无统计学意义[分别为0、4.2％(2/48),P=0.066].结论 经鼻蝶垂体腺瘤切除术中应用多模态神经导航有助于辨识解剖学结构,减少手术创伤,缩短手术时间.

Postoperative delirium (POD) is a complication characterized by disturbances in attention, awareness, and cognitive function that occur shortly after surgery or emergence from anesthesia. Since it occurs prevalently in neurosurgical patients and poses great threats to the well-being of patients, much emphasis is placed on POD in neurosurgical units. However, there are intricate theories about its pathogenesis and limited pharmacological interventions for POD. In this study, we review the recent insights into its pathogenesis, mainly based on studies within five years, and the five dominant pathological theories that account for the development of POD, with the intention of furthering our understanding and boosting its clinical management.

Objective:To explore the feasibility and effect of microchannel keyhole technique in minimally invasive resection of symptomatic sacral cysts.Methods:The clinical data of 45 patients with symptomatic solitary sacral cyst who were admitted to the Department of Neurosurgery, Peking University Third Hospital from February 2017 to December 2019 were retrospectively analyzed. All 45 patients underwent individualized laminectomy of posterior wall of sacral canal and then microsurgical resection of cyst through microchannel (width ≤1.5 cm). The patients′ pain conditions were evaluated based on the visual analogue scale (VAS) and their neurological functions were assessed using the Japanese Orthopedics Association (JOA) scale. The recurrence of cyst was evaluated by imaging follow-up.Results:The operation duration was 97.0±12.6 min (75-120 min). The length of hospital stay post operation was 6±1 days and ranged from 5 to 9 days. Of 45 patients, total resection of sacral cysts was achieved in 41 cases and subtotal resection with distal cyst wall remaining in 4 cases. Pathological results showed that all of sacral cysts were simple cysts. Except for 4 patients with numbness in the sacrococcygeal region after operation, the remaining 41 patients did not experience aggravation of neurological dysfunction. Forty-five patients were followed up for 3 to 36 months after surgery (median: 15 months). All 4 patients with sacrococcygeal numbness returned to normal, and no cyst recurrence was seen. The last follow-up VAS was 0 to 3 points (median: 0 points), and compared with 1 to 10 points before surgery (median: 3 points), the difference was statistically significant ( Z=-5.866, P<0.001). The JOA score at the last follow-up (28.7±1.1 points; range: 22-29 points) increased compared with that prior to operation (21.6±3.9 points; range: 14-28 points) and the difference was statistically significant ( t=-13.726, P<0.001). Conclusion:The application of microchannel keyhole approach in the minimally invasive treatment of symptomatic sacral cysts can effectively relieve the clinical symptoms with few complications and low recurrence rate.

Background Idiopathic spinal cord herniation is an extremely rare entity that is characterized by protrusion of the spinal cord through a defect in the ventral dura. Due to the paucity of enough clinical evidence, the treatment and prognosis of idiopathic spinal cord herniation are still elusive. Herein, we reported a case of idiopathic spinal cord herniation occurring at the C7–T1 levels that was treated by surgical reduction. Case description A 44-year-old Chinese woman presented with a 5-year history of numbness and weakness in the bilateral lower limbs. Spinal magnetic resonance imaging demonstrated ventral displacement of the spinal cord at the C7–T1 levels, and there seemed to be a cuneiform space-occupying lesion dorsal to the spinal cord. A diagnosis of the spinal intradural extramedullary tumor was suspected. An exploratory operation was performed via a posterior midline approach. Intraoperatively, we found a defect in the ventral dura through which the spinal cord herniated to the epidural space. After the herniated parenchyma was returned, an artificial dura matter was used to repair the defect. The postoperative course was uneventful. After a 3-month follow-up, the lower-extremity weakness was significantly improved, and there was no recurrence of the spinal cord herniation. Conclusion Preoperative diagnosis of idiopathic spinal cord herniation is exceedingly challenging. Surgical reduction of the herniated spinal cord with the repair of the dural defect is an effective approach for the treatment of this rare disorder, and the surgical outcome is favorable.

Objective To summarize the effect of “four-step” method in robot-guided percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. Methods Clinical data of 20 patients with trigeminal neuralgia who underwent robot-guided percutaneous balloon compression of the gasserian ganglion from June 2020 to November 2021 were retrospectively analyzed. The median Visual Analogue Scale（VAS） score of the 20 patients before surgery was 8（range, 7-10）. Preoperative planning and surgery were performed with a “four-step” process:（1）preliminary positioning on three-dimensional images;（2）determination of puncture direction on sagittal and coronal CT images;（3）fine-tuning of the relationship between puncture path and Meckel’s sac on MRI images; and（4）low-resistance puncture. Results All the patients successfully received the operation, and the intraoperative lateral X-ray balloon showed a typical “pear shape”. The pain symptoms were relieved immediately after operation, with the VAS scores being 0 in 17 cases and 1 in 3 cases. Postoperative operation-sided numbness with unilateral sensory dysfunction of half of the tongue were observed in all the patients, masticatory muscle strength decreased in 15 patients, corneal reflex decreased in 1 patient, and oral herpes occurred in 3 patients. The patients were followed up for 3-23 months（mean, 10.7±5.1 months）. The VAS score was 0 in all the patients, and no trigeminal neuralgia recurred. Residual mild facial numbness was found in 2 cases, while facial numbness, lingual dysesthesia, masticatory muscle weakness, hypocorneal reflexes and oral herpes disappeared in the other 18 cases.Conclusion Using the “four-step” method to implement the robot-guided percutaneous balloon compression of the gasserian ganglion has satisfactory results.

目的 探讨成人椎管内畸胎瘤合并脊髓拴系综合征的显微手术方法和效果.方法 回顾性分析2010年9月～2020年12月31例成人椎管内畸胎瘤合并脊髓拴系综合征的临床资料.肿瘤长径1～3.8 cm,平均2.2 cm.临床症状包括腰背痛21例,下肢及鞍区感觉障碍(麻木)10例,下肢力弱14例,大小便功能障碍15例.采用显微手术切除肿瘤内膜和肿瘤实体,于硬膜囊末端切断终丝.结果 肿瘤9例全切除,22例次全切除;肿瘤内膜27例全切除,4例次全切除.手术时间110～155 min,平均127 min.术后病理均为成熟囊性畸胎瘤.术后无感染,无死亡.新发神经功能障碍6例,包括节段性感觉减退3例(3个月恢复正常),排尿困难5例(6个月恢复正常);其余25例无神经功能障碍加重.术后随访5～36个月,中位数24个月.1例内膜次全切除者术后1年畸胎瘤复发再次手术,其他30例未见复发,未见再拴系.疼痛视觉模拟评分(Visual Analogue Scale,VAS)显著降低,日本骨科协会(Japanese Orthopedic Association,JOA)评分和JOA括约肌功能评分显著升高(P<0.05).结论 椎管内畸胎瘤合并脊髓拴系综合征时,需要尽可能切除畸胎瘤内膜,降低复发概率,松解粘连并于硬膜囊末端切断终丝,缓解神经受压和牵拉症状.

目的 探讨“四分区法”及个体化入路在显微手术治疗颈椎椎旁神经源性肿瘤中的应用价值. 方法 回顾性分析我科2013年1月～ 2018年12月显微手术治疗颈椎椎旁神经源性肿瘤42例资料.根据“四分区法”,肿瘤位于Ⅰ区6例,Ⅱ区5例,Ⅲ区5例,Ⅳ区7例,Ⅰ和Ⅱ区6例,Ⅰ、Ⅱ和Ⅲ区2例,Ⅱ和Ⅲ区3例,Ⅲ和Ⅳ区6例,Ⅱ、Ⅲ和Ⅳ区1例,Ⅰ、Ⅱ、Ⅲ和Ⅳ区1例.根据肿瘤主体所在节段及区域选择手术入路,采用后方旁正中入路12例,后侧方人路2例,颌下入路2例,胸锁乳突肌前人路9例,胸锁乳突肌后入路7例,锁骨上入路6例,经口腔入路1例,胸锁乳突肌前后联合入路2例,胸锁乳突肌后联合后方旁正中入路1例.术中行神经电生理监测. 结果 42例肿瘤均完全切除,病理诊断神经鞘瘤32例,神经纤维瘤10例.术后3例声音嘶哑,1周恢复,1例上肢肌力下降,3个月恢复,无其他并发症.术后随访12 ～84个月,中位数48.5月,无肿瘤复发. 结论 术前对颈椎椎旁肿瘤进行分区,根据分区个体化选择入路行显微手术安全有效.

Objective:To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions.Methods:A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2021. Before surgery, the patient’s skull MRI with enhancement, diffusion tensor imaging (DTI), and CT angiography (or magnetic resonance angiography) data were fused to reconstruct nerve tracts, tumors, blood vessels, skulls and other structures, so as to design the optimal surgical path, and used in neuronavigation to guide tumor resection. Degree of tumor resection was evaluated by using MRI results 72 hour post operation. One week, one month, and three months after surgery, the Boston Diagnostic Aphasia Examination (BDAE) was used to assess language function, and the simplified Fugl-Meyer Assessment (FMS) was used to assess motor function.Results:Through the three-dimensional image reconstruction, the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts, arteries and veins were clearly shown, the displacement and destruction of the nerve tracts were clarified, and the blood supply arteries and drainage veins were shown. Among the 30 patients, the tumor involved the motor area in 21 cases and language area in 25 cases. Totally resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). Among the 21 patients with preoperative neurological deficits, at the last follow-up, 20 patients had improved neurological function after surgery, and 1 patient had unchanged neurological function compared with presurgical conditions. Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery, which resolved after 1 week.Conclusion:The use of multimodal images to three-dimensionally reconstruct tumors and surrounding nerve fiber bundles, blood vessels and other important structures, so as to design surgical approaches and apply them to intraoperative navigation to guide the operation, could help protect the eloquent brain area and improve the efficacy of surgery.

目的 探讨微通道辅助经椎旁肌间隙入路(Wiltse入路)显微手术切除胸腰椎椎旁肿瘤的效果.方法 回顾性分析2017年2月 ～2020年3月12例胸腰椎椎旁肿瘤的临床资料,包括腰椎椎旁肿瘤8例,胸椎椎旁肿瘤4例.肿瘤长径1.5～3.5 cm,平均2.3 cm.临床症状包括相应神经支配区疼痛10例,感觉障碍(麻木)6例,下肢肢体无力1例.采用微通道辅助下椎旁肌间隙入路,显微手术切除肿瘤.结果 12例肿瘤均获全切除.手术时间60～100 min,平均78.5 min;术后住院时间4～7 d,平均5.3 d.术后病理均为神经鞘瘤.术后无感染,无死亡.均无明显腰背部疼痛.1例节段性感觉减退,6个月恢复正常;其余患者无神经功能障碍加重.术后随访3～36个月,中位数19.5月,未见脊柱畸形,未见肿瘤复发或残留.结论 微通道辅助经椎旁肌间隙入路显微手术切除胸腰椎椎旁肿瘤有利于避免多裂肌附着点和小关节的破坏,保护多裂肌及其供应血管和支配神经,有利于保持胸腰椎稳定性,避免术后慢性腰痛的发生.

Objective:To explore the clinical application of robot-assisted intracranial lesion biopsy in elderly patients.Methods:A retrospective analysis was conducted on the clinical data of 30 elderly patients (72-93 years old) who underwent robot-assisted intracranial lesion biopsy at the Department of Neurosurgery, Peking University Third Hospital from March 2019 to March 2021. Pathological examinations were performed after the operation, and the surgical accuracy of the robot was evaluated, including navigation accuracy errors and puncture accuracy errors. The multiple linear regression method was used to determine the clinical factors that affected the accuracy of puncture.Results:The puncture needles of 30 patients were all inserted into the target lesion at one time, and the needle tips were all located in the lesion tissue. After the operation, 1 patient developed bleeding in the target area (hematoma volume <10 ml); 1 patient developed epileptic seizure. All 30 patients received pathological examinations, which revealed neoplastic lesions in 24 cases, including lymphomas in 10 cases, metastatic carcinomas in 6 cases, neuroepithelial tumors in 5 cases and germ cell tumors in 3 cases. The other 6 patients had non-neoplastic lesions, including 4 cases of non-specific inflammation, 1 case of multiple sclerosis and 1 case of demyelinating disease. The robot navigation accuracy of 30 patients was 0.4±0.2 mm (0.1-0.7 mm), the puncture accuracy was 1.0±0.2 mm (0.6-1.3 mm), and the navigation accuracy was higher than the puncture accuracy ( t=-11.64, P<0.01). The results of multiple linear regression analysis showed that gender, age, and whether the lesion was tumor or not had no effect on the puncture accuracy (all P>0.05), and whether there was extensive brain atrophy was the clinical factor that affected the puncture accuracy ( t=-2.52, P<0.05). Conclusion:Robot-assisted biopsy for elderly patients with intracranial lesions has few postoperative complications and high puncture accuracy, while it might affect the puncture accuracy when accompanied by extensive brain atrophy.

Objective:To explore the effect of laparoscope-assisted placement of the peritoneal end of the catheters in ventriculoperitoneal (VP) shunt.Methods:This retrospective study was performed on the clinical data of 32 cases with hydrocephalus admitted to Department of Neurosurgery, Peking University Third Hospital from May 2018 to November 2019. All patients were treated with ventriculoperitoneal shunt and the peritoneal ends of the catheters were placed with the assistance of laparoscopes. The results of clinical follow-up were evaluated by using Salmon criteria and Karnofsky performance status score (KPS). The change of hydrocephalus was assessed based on the Evans index during imaging follow-up.Results:All patients successfully underwent laparoscope-assisted VP shunt. The operation time ranged from 65 to 75 minutes with an average of 70.1±2.9 minutes. The operation time at the abdomen was 16.1±1.5 minutes (range: 14-20 minutes). The length of hospital stay post operation ranged from 6 to 9 days with a median of 7 days. The median length of bed rest was 2 days post operation with the range of 2-3 days. No intracranial infection, cerebrospinal fluid leakage, abdominal organ injury, shunt occlusion or death was reported. One patient developed the symptom of hiccup which was resolved after conservative treatment. The patients were followed up for 3 to 22 months with an average of 12.2±6.1 months. According to the Salmon criteria, grade 3 was reported in 2 cases (6.3%), grade 2 in 18 cases (56.2%) and grade 1 in 12 cases (37.5%). The KPS score of 32 patients improved from an average of 59.1±10.0 points (40-80 points) prior to operation to an average of 77.5±10.8 points (50-100 points) at the latest follow-up with significant difference ( t=-13.826, P<0.001). There was also significant difference between postoperative Evans score (median: 0.29, quartile: 0.04) and preoperative Evans score (median: 0.36, quartile: 0.02) ( Z=-4.961, P<0.001). Conclusion:Laparoscopically assisted VP shunt has the advantages of being minimally invasive and accurate, which can help to accelerate postoperative recovery and reduce the incidences of abdominal catheter blockage, abdominal complications as well as infections.

Objective:To explore the diagnosis and surgical treatment outcome of pituitary abscess.Methods:The clinical data of 14 cases of pituitary abscess admitted to Department of Neurosurgery, Peking University Third Hospital from September 2000 to September 2019 were analyzed retrospectively in this study. All patients underwent abscess debridement via endonasal transsphenoidal approach. The pus and tissue of pus wall were collected during operation for pathogenic examination, and anti-infection treatment was administered post operation. At 2 weeks after operation, the head MRI and routine blood test were performed. All patients received regular clinical and imaging follow-up to explore the improvement of clinical symptoms and recurrence of abscess.Results:The main clinical symptoms of 14 patients were headache (13/14), vision decline (10/14), hypopituitarism (8/14), diabetes insipidus (6/14). In this series, 8 patients had the history of infection and 7 of them had sinusitis. The lesions of sellar region or lesions of sellar region and suprasellar region were revealed by both CT and MRI. The central cystic changes were observed on MRI (14/14), and ring enhancement (11/14) or irregular enhancement (3/14) was shown on enhanced MRI. A total of 14 patients were reviewed 2 weeks after operation, and the abscess disappeared. There was no death or infection. A large number of neutrophils, plasma cells, lymphocytes or necrotic tissues were found in the pus smear of 14 patients. Pathogenic bacteria were detected in 3 cases including Gram-positive bacteria in 2 cases and Gram-negative bacteria in 1 case. The follow-up time of 14 patients was 4.5±1.2 months (3-6 months). During follow-up, the body temperatures of all patients were normal. Preoperative headache and declined vision were improved. Out of 8 patients with hypopituitarism, 7 recovered obviously and only 1 patient still underwent drug replacement treatment. Out of 6 patients with diabetes insipidus, 4 recovered completely and the urine volumes of the remaining 2 patients were reduced significantly. At the latest follow-up, no recurrence of abscess was reported based on enhanced MRI of sellar region.Conclusions:The pituitary abscess is nonspecific in terms of clinical features and thus easy to be misdiagnosed. When the patient has a history of infection, diabetes insipidus or hypopituitarism, and medical imaging suggests that there is cystic lesion in the sellar area, the possibility of pituitary abscess should be considered. The outcome of pituitary abscess seems good following endonasal transsphenoidal operation and reasonable postoperative anti-infection treatment.