Objective To conduct the comparative observational study of serum neoplastic biomarker and immunohistochemistry in intracranial getm cell tumors (GCTs).Methods A retrospective study was conducted on clinical data of 28 cases of germ cell tumors undergoing surgery from March 2013 to July 2016 at Tsinghua University Yuquan Hospital.Presurgical serum neoplastic biomarkers including α-fetoprotein (AFP),β-human chorionic gonadotropin (β-HCG) and alkaline phosphatase (ALP) were measured and compared with postsurgical immunohistochemistry results of tumor specimens.Results Among the 28 cases of GCTs,germinoma was identified in 5 cases,teratoma in 2 cases,immature teratoma in 5 cases,choriocarcinoma in 1 case and mixed germ cell tumor in 15 cases.AFP was inconsisent in 8/28 cases,being positive in serum biomarker and negative in immunohistochemistry,and included 4 cases of immature teratoma and 4 mixed GCTs.β-HCG was incongruent in 5 cases (positive in serum and negative in immunohistochemistry).Among the 18 cases with pure germinoma component,placenta ALP (PLAP) immunohistochemistry revealed positive results in 15 cases,while serum ALP was significantly increased in only 4 cases and not detected in the remaining 14 cases.Conclusions The treatment and prognosis of intracranial GCTs might be correlated with different neoplastic components.Immunohistochemistry combined with serum biomarker could help demonstrate those neoplastic components more accurately and completely.

Objective: To study intracranial mixed germ cell tumor diagnosis and reasonable treatment strategy. Methods: Clinical data of 17 patients with intracranial mixed germ cell tumor in Tsinghua university Yuquan hospital from October 2012 to October 2016 were retrospective analysed, including the characteristics of the general, the serum tumor markers of AFP, β-HCG, and CEA, imaging findings, pathological results, treatment methods and prognosis. Results: There were 10 cases of male, 7 cases of female. The average age was (11.1±5.2) years old. Nine cases were gross total resection of lesions and 8 cases were subtotal resection of lesions. Eight cases (47.1%) were without recurrence and had more than four courses of chemotherapy after surgery, of which, 7 cases belonged to the gross total resection, and 1 case belonged to the subtotal resection. Nine (52.9%) patients relapsed, including 2 cases of the gross total resection and 7 cases of the subtotal resection. Among them, 4 cases were given second operations and 6 cases obtained satisfactory therapeutic effect by chemotherapy combined radiotherapy. There were 12 of 17 patients with pathological types contain teratoma (including mature, immature or malignant teratoma) ingredients, accounting for 70.6%. The average follow-up time was (17.5±12.1) months, 4 cases (23.5%) patients died. Conclusion: The diagnosis of intracranial mixed germ cell tumors needs comprehensive consideration of tumor markers in serum or cerebrospinal fluid, chemotherapy and radiotherapy before operation and pathological results. The gross total resection helps to reduce the chances of tumor recurrence. Rational chemotherapy and radiotherapy is helpful to prognosis.

Objective To investigate the comprehensive treatment and prognosis of primary intracranial choriocarcinoma of familial tendency.Methods Two whole sisters admitted to the Department of Neurosurgery,Yuquan Hospital,Tsing Hua University in June 2013 and confirmed as primary choriocarcinoma in sellar region by pathology were summarized.Their ages of onset were 9 and 11 respectively.The lesion site was in the sellar region.The preoperative tumor markers suggested abnormally increased β-HCG; their choriocarcinomas were resected after giving a course of ICE chemotherapy.The elder sister was operated via interhemispheric fissure-corpus callosum-between the fornices approach and the younger one was operated via crown cut-frontal anterior longitudinal fissure approach.They underwent regular chemotherapy after surgery and did not undergo radiotherapy.Results The 2 choriocarcinomas achieved near-total resection under the microscope.They all recovered well after surgery and did not have serious complications in saddle regions,and both were pathologically confirmed as choriocarcinoma.The examination before discharge showed that β-HCG turned to negative.They had 5 regular chemotherapies,and they were followed up to now and their choriocarcinomas did not recur.Conclusions Primary intracranial choriocarcinoma is high malignant and it is rare in clinical practice.Its familial predisposition onset is rarely reported.As long as the diagnosis is clear,the use of regular chemotherapy and appropriate surgical approach may achieve a satisfactory efficacy.If it can be studied from genomics,it might be able to achieve a breakthrough on the basis of primary intracranial choriocarcinoma.

Objective The purpose of this research is to find a credible guideline for prognosis and re-exploration of Hemifacial spasm.Methods To analyze the data of 300 patients with delayed resolution after MVD.Descriptive statistics were performed with SPSS 15.0.Results The mean of time of delayed resolution was 129.0 days,M =50.0 days.The 95％ confidence interval(95％ CI) of delayed resolution was (105.4,152.5) days.Age (P =0.045),course of disease (P =0.029),and post-surgery tic severity (P ＜ 0.001) were significant influences on the delayed resolution.Silent period was found in 42.7％ patients.The mean of silent period was 1.36 days,57.3％ within 24 hours.Conclusion The statistical time of cure rate should not be less than 2 years.Re-operation was reasonable if the symptoms persist more than 2 years(except for the cases of symptoms were relieved) or tend to get worse progressively when followed at least six months.The follow time would been prolonged for elder and/or long suffering.

Objective:To investigate the use of microvascular decompression for treatment for elderly patients with primary hemifacial spasm effects.Method:To retrospectively analyze the application microvascular decompression for treatment of elderly patients with primary hemifacial spasm.Result:656 patients cured,total cure rate was 98.17%,and 2 cases of recurrence.Conclusion:Microvascular decompression for the surgical treatment of elderly patients with primary hemifacial spasm is effective.

Objective To evaluate the psychological states of the patients of hemifacial spasm(HFS) before and after operation. Methods The patients were assessed with Self rating Anxiety Scale(SAS) and Self rating Depression Scale(SDS) before and after operation. It showed that patients had anxious and depression psychological state universally. Result Surgical treatment had good result but the anxious and depression psychological state had no obvious improvement than that before operation. Whereas, the anxious and depression psychological state had obvious improved 6 month after surgery. Conclusion The anxious and depression psychological state can not be significantly improved by operation in a short time after procedure. But the psychological state can get very significant improvement at a specified future date.

Objective To study cerebrospinal fluid dynamics in cerebral aqueduct after endoscopic aqueductoplasty in patients with aqueduct obstructive hydrocephalus using phase-contrast cine magnetic resonance imaging.Methods A total of 10 healthy volunteers and 21 patients with aqueduct obstructive hydrocephalus who received endoscopic aqueductoplasty were included in this study.Cerebrospinal fluid flow rate was measured with phase-contrast cine magnetic resonance imaging and statistics was performed in different groups.Results Two important parameters of cerebrospinal fluid dynamics,flow rate in systole period and time to peak rostrocaudal flow velocity with R-R correction(Time to Vr),were used for statistical analysis by comparing with the healthy volunteers.It was indicated by t-test that there was no significant difference between patients and healthy volunteers.Conclusion Cerebrospinal fluid dynamics in aqueduct after endoscopic aqueductoplasty is similar to that of normal cerebrospinal fluid flow,which indicates that endoscopic aqueductoplasty can restore the normal physiological circulation.

Objective To investigate the value of Codman Hakim pressure - adjustable shunt in the treatment of hydrocephalus associated with congenital intracranial anomalous venous return.Methods 2 patients whose diagnosis were confirmed by CT,MRI,MRV and DSA and programmable ventriculoperitoneal shunting was given.Results The pressure of 2 cases of patients undergoing shunt valve was set to 200 mmH2O in operation and the pressure was reduce gradually.The patients developed symptoms of low intracranial pressure in different degrees when the pressure was reduced to 180 mmH2O.The symptoms were alleviated after the pressure was increased.The mental and motor function of 2 patients were improved significantly and CT examinations showed decreased ventricles.Conclusious The hydrocephalus associated with congenital intracranial anomalous venous return is rare and the treatment experience is not enough.Pressure - adjustable shunting is the best treatment for this kind of hydrocephalus.The pressure should be adjusted several times for a long time to achieve a suitable individual pressure gradually.

Objective To summarize the indication,method and effect of individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet.Methods The clinical data of 32 cases of obstruction of fourth ventricle outlet treated by individual flexible endoscopic procedure from July,2006 to June,2010 were analyzed retrospectively.Results Single endoscopic fourth ventriculostomy (EFV) was performed in 9 cases,EFV with endoscopic third ventriculostomy (ETV) in 5 cases,endoscopic aquductoplasty (EAP) with ETV in 5 cases,EAP with EFV in 2 cases,and single ETV in 11 cases.In cine phase- contrast magnetic resonance imaging( cine - MRI),26 (81.3％) cases showed fine circulation of CSF in aqueduct,10 (31.3％) fine circulation of CSF in Magendie's foramen and 15 (46.9％ ) fine circulation of CSF in the orificium fistulae of third ventricle floor.2 (6.3％ ) cases were symptomatic relief although unsatisfactory result appeared in postoperative cine - MRI.Of 5 ( 15.6％ ) cases who still suffered from postoperative intracranial hypertension,2 (6.3％ ) cases were released by external ventricle drainage for several days,3 (9.4％ ) cases had to had ventriculoperitoneal (VP) shunt because the intracranial hypertension could not be released.There was no complication related to operation appeared in all patients.Conclusions The obstruction of fourth ventricle outlet could be treated individually through trans - aqueduct approach via frontal key - hole with flexible neuroendoscope.Regular CSF circulation could be put back with shunt - free in partial patients,but the operative indication should be obeyed strictly.

Objective To study the clinical characters and therapy of the neurosarcoidosis.Methods Combined with review of the literatures,the history and clinical data of a patient suffered from hypothalamus neurosarcoidosis,whose diagnosis was confirmed by MRI,corticotherapy and pathological diagnosis after partial resection via interhemispheric trans - lamina terminalis approach,were analyzed.Results The neurosarcoidosis was very rare.The diagnosis was often difficult before operation.Most patients who suffered neurosarcoidosis had findings suggestive of multisystem disease,particularly lung and cardiac involvement.After pathological diagnosis,the effect of corticotherapy was usually satisfactory.Conclusion The diagnosis of neurosarcoidosis is made by observing an appropriate clinical history with neurologic signs or symptoms,accompanied by findings on the biopsy.The early corticotherapy of full dose was approved to be an effective method.

Objective The aim of this study was to assess the values of detecting intracranial residual aneurysms by three - dimensional digital subtraction angiography (3D - DSA) after clipping. Methods 3D - DSA and DSA were performed on 29 patients (35 aneurysms) after 3 to 6 months of clipping to assess the effect of detecting residual aneurysms by 3D - DSA contrasting to DSA. Results 10 residual aneurysms were detected by 3D - DSA, in which 8 neck residual aneurysms had been confirmed as the neck residual aneurysms, the other 2 residual dome aneurysms could not be confirmed as the completely clipped aneurysms in operations; However, only 3 aneurysms were detected by DSA, in which 1 neck residual aneurysm and 2 residual dome aneurysms were in line with the results of3D -DSA. While the other 7 residual aneurysm, which were detected by 3D - DSA, appeared as false negative results. Conclusion The effect of detecting residual aneurysms after clipping by 3D - DSA was obviously better than by DSA. 3D -DSA was more sensitive and accurate, especially in detecting the less neck remnant aneurysms. 3D - DSA was good at observing the morphologic change of residual aneurysms in long - term follow - up after clipping.

Objective To investigate the value of electrical flexible neuroendoscopic management of the fourth ventricular cysticercosis.Methods 2 cases of fourth ventricular cysticercosis were transaqueductally removed with an electrical flexible neuroendoscope.In one case,the preoperative MRI showed a cystic lesion in the fourth ventricle.In another case,the preoperative MRI showed the cystic lesion in the third ventricle,but during the course of exploration of ventricles under neuroeodoscope,the lesion was found to have migrated into the fourth ventricle.Results Complete excision of cysts in the fourth ventricle was performed in both patients with no significant operative or postoperative complications.Satisfactory postoperative CSF flow around foramen magnum was detected by cine phase-contrast magnetic resonance imaging.Conclusions The whole ventricular system can be explored easily with electrical flexible neuroendoscope.Electrical flexible neuroendoscopic management of the fourth ventricular cysticercosis should be the optimal choice due to its minimal invasion,less complications,shorter length of stay and cheaper treatment costs.

Objective To discuss the clinicopathologic characteristics of surgically removed tissues in patients with intractable epilepsy. Methods From 2008 to 2009, the histological sections of 172 specimens of cerebral epileptogenic foci, which were acquired by surgery, were performed respectively by HE staining and immunohisto - chemical staining,the characteristics of clinical pathology were also analyzed. Results Of all the 172 cases, according to the pathological features of the epilepto -genic foci, there were 138 focal cortical dysp lasia (FCD) ,including 115 FCD ⅠB, 15 FCD ⅡA and 8 FCD ⅡB, 2 micro cortical dysplasia, 4 dysembryoplastic neuropithelial tumors,7 Rasmussen's encephalitis, 16 ulegyrias; 1 ganglioneuroma; 1 microgyria malformation, 1 vascular malformation, 1 hypothalamic hamartoma, 1 tuberous sclerosis. ConclusionFCD is the most commonly present in intractable epilepsy, and FCDⅠB is most common among the FCD.

ObjectiveTo study the application of neuro-endoscope to the treatment of patients with shunt malfunction. MethodsA total of 52 patients with shunt malfunction were treated with neuro-endoscopic procedures from June 2005 to July 2008. ResultsIn the 52 cases, 36 ( 69%) were free from shunt after endoscopic procedure. Among them, no other operative complications appeared except for 1 case with postoperative intraventricular hemorrhage who was cured by ventricular out-drainage and 1 case with transient diabetes insipidus who was cured with medicine. Two cases (2/52, 4%) were free from shunt after endoscopic procedure but the shunting catheter could not be dislodged due to blood vessels or brain tissue surrounding. However,14 cases (14/52, 27%) could not be free from shunt and had to have a re-shunt after the ventricular circumstances got improved by endoscopic ventricular irrigation, out-drainage, and shunting catheter dislodgment. ConclusionEndoscopic ventricular inspection can define the cause of malfunction in hydrocephalus. Some patients can be free from shunt after endoscopic procedures.

目的探讨可调压式分流管在脑积水治疗中的优点。方法采用可调压式分流管治疗18例不同类型脑积水病人。依据病人年龄、病因、影像学检查及腰穿测脑脊液压力作为病人初始开放压力技术后调压的依据。结果术后调压次数2～6次,平均2.3次。术前临床症状在术后均得到明显改善或消失。结论可调压式分流管治疗脑积水可减少分流过度或不足等并发症,特别适合婴幼儿、老年人、正常压力及特殊类型的脑积水病人。

<正>2005年7月～2007年12月,我院治疗20例第三脑室造瘘术后间脑发作病人,效果良好,现总结并报告如下。1对象与方法1.1一般资料男12例,女8例;年龄52d～25岁,平均3.4岁,其中<3岁16例。包括中脑导水管狭窄导致非交通性脑积水5例,脑室内出血导致先天性脑

Objective To investigate into different surgical approaches for peripheral facial palsy. Methods Surgical experiences from 12 patients with peripheral facial palsy were retrospectively analyzed, including 5 cases of Bell's palsy, 3 temporal bone fracture, 3 cerebellopontine angle tumor, and 1 parotid injure. Preoperative House-Brackmann grade was Ⅳ in 8 cases, and Ⅴ in 4. Results The approach included facial decompression in 8 patients, neuroanastomosis in 3, and nerve grafting in 1. No such postoperative complications occurred as sensorineural hearing loss, cerebrospinal fluid leak, and injury to the chorda tympani, jugular bulb and sigmoid sinus due to operation. The average follow-up period was 1.2 years. House-Brackmann grade was Ⅰ in 2 cases, grade Ⅱ in 6, and grade Ⅲ in 4. Conclusion An appropriate surgical approach for peripheral facial palsy can render a good prognosis.