Objective: Access to the pineal region has always represented a formidable challenge to the neurosurgeons. This study aims to explore the surgical techniques of the occipital transtentorial approach (OTA) without using brain retractor for excision of pineal region tumors based on the author’s experience and literature review. Methods: A retrospective analysis was performed of patients who underwent surgery for pineal tumors via OTA using dynamic retraction at our institution from 2018 to 2022. The clinical data, surgical procedure, and results were examined. Results: Twelve patients underwent surgery via OTA for treatment of pineal tumors. In all cases, it was feasible to complete surgery without using brain retractor. Gross total resection was achieved in 10 cases (83.3 %), while subtotal resection in 2 cases (16.7 %). There were no mortalities. Three patients presented with upper gaze palsy after surgery, 2 of them experienced complete recovery at the third month follow-up. Only one patient had residual neurologic deficit. Two patients reported transit diplopia after surgery. No postoperative hemianopsia was observed in this series. Conclusion: The occipital transtentorial approach is effective for the removal of tumors in the pineal region. Dynamic retraction with handheld instruments and meticulous dissection of arachnoid membrane around the deep veins can provide a sufficient working space.

目的 探讨不同年龄段的中枢神经系统(CNS)血管母细胞瘤(HB)的临床特征、预后及其影响因素.方法 回顾性分析2016年1月至2022年1月手术治疗的86例CNS-HB的临床资料.根据初次手术年龄分为四个年龄段(≤20岁、21～40岁、41～60岁和≥61岁),分析不同年龄段临床特征、预后差异.结果 CNS-HB以颅内压增高症状为主,其次是小脑症状.肿瘤主要位于幕下,其中小脑占65.6％、脑干占17.7％,其次是脊髓(11.5％),幕上极少(5.2％);实性肿瘤43例(44.8％),囊性肿瘤53例(55.2％).年龄≤20岁组病程[(1.68±1.87)个月]较年龄≥61岁组[(26.50±50.66)个月]明显缩短(P<0.05).年龄≤40岁病人VHL病发生率较年龄>40岁病人明显增高(P<0.05).不同年龄段病人的肿瘤部位、肿瘤性质均无明显差异(P>0.05).术后41例(42.7％)出现坠积性肺炎,年龄越大,发生肺炎的几率越高(P<0.001).术后15例(15.6％)出现颅内并发症,实性肿瘤及脑干肿瘤病人术后颅内并发症发生率明显高于囊性肿瘤或肿瘤位于其他部位病人(P<0.05).末次随访,预后良好78例(81.3％),预后不良8例(18.7％).多因素logistic回归分析显示男性、肿瘤位于脑干以及实性肿瘤是CNS-HB预后不良的独立危险因素(P<0.001).结论 年轻HB病人的病程较短,而老年HB病人术后并发症发生率较高,但是年龄不是HB病人预后不良的危险因素,肿瘤部位及肿瘤性质与HB病人不良预后有关.40岁以下病人VHL病发病率较高,建议年轻病人积极进行VHL病的筛查.

目的:明确缺血性脑卒中(IS)后不同区域脑组织中干扰素调节因子4(IRF4)表达水平的变化趋势并探讨其在IS后神经功能损伤中的保护作用与可能机制.方法:首先通过短暂性大脑中动脉闭塞(tMCAO)构建小鼠IS模型(包括野生型和IRF4基因敲除组),随后分别利用RT-PCR与Western Blot检测核心梗死区域、缺血半暗带与对侧正常脑组织内IRF4mRNA与蛋白表达水平.同时利用ELISA检测缺血半暗带区域促炎细胞因子IL-1β、IL-6与TNF-α的表达水平.分别利用RT-PCR与Western Blot检测M1型巨噬细胞标志物iNOS与M2型巨噬细胞标志物Arg-1的mRNA与蛋白表达水平;随后进行神经功能评分与水迷宫试验检测逃逸潜伏期(EL),利用2,3,5-氯化三苯基四氮唑(TTC)染色检测小鼠脑梗死体积,同时利用免疫荧光染色检测细胞凋亡.结果:缺血半暗带IRF4表达水平较核心梗死区域与对侧正常脑组织均明显增加.此外,缺血半暗带促炎细胞因子IL-1β、IL-6与TNF-α表达均明显增加,且与IRF4表达水平呈明显负相关;iNOS表达明显上调且Arg-1表达显著减少.而IRF4基因敲除导致IS小鼠脑梗死体积增加且神经功能明显恶化.IRF4基因敲除致使1S小鼠脑组织促炎细胞因子表达显著上调,巨噬细胞标志物检测表明IRF4基因敲除致使巨噬细胞向M1型极化.此外,IRF4基因敲除导致神经元凋亡明显增加.结论:IS显著诱导缺血半暗带IRF4表达,IRF4敲减可导致IS小鼠炎症反应加重,巨噬细胞向M1型极化且神经功能损伤明显恶化.因此,IRF4表达可能通过调节巨噬细胞极化,抑制促炎细胞因子表达,继而在IS中发挥抗炎和脑保护作用.

目的 探讨经Dolenc入路手术夹闭基底动脉顶端动脉瘤的手术方法及治疗效果.方法 回顾性分析2014年6月至2022年6月经Dolenc入路手术治疗的26例基底动脉顶端动脉瘤的临床资料.结果 术后2周CTA检查显示26例基底动脉顶端动脉瘤均完全夹闭.术后出现动眼神经麻痹5例、脑积水1例(脑室-腹腔分流术)、偏瘫1例,无脑脊液漏,无手术死亡病例.26例术后随访6～48个月;动眼神经麻痹5例中,术后3个月内完全恢复4例,部分恢复1例;1例脑积水行脑室-腹腔分流术后恢复良好,1例偏瘫恢复生活自理.术后6个月改良Rankin量表评分0分16例,1分3例,2分4例,3分3例;CTA复查未见基底动脉顶端动脉瘤复发,载瘤动脉通畅.结论 显微手术是治疗基底动脉顶端动脉瘤的重要方式,经Dolenc入路手术可获得良好的效果.

目的 探讨立体定向辅助下双侧内囊前肢毁损术(ALIC-RSF)治疗难治性精神分裂症(SCZ)伴发的攻击行为的疗效.方法 回顾性分析2019年6月至2021年1月立体定向辅助下ALIC-RSF治疗的35例伴攻击行为的难治性SCZ的临床资料.术前、术后3个月、术后1年,使用外显攻击量表(MOAS)、阳性及阴性症状量表(PANSS)、蒙特利尔认知评估量表(MoCA)、社会功能缺陷筛选量表(SDSS)评估疗效.使用R软件,采用LASSO回归分析检验PANSS评分与术后12个月MOAS评分的相关性.结果 术后3、12个月,MOAS评分、PANSS评分、SDSS评分均显著改善(P＜0.05),而MoCA评分无明显变化(P＞0.05).手术相关并发症大多在术后2周恢复,2例术后1年表现轻度行为懒散、兴趣缺乏的症状.术后12个月MOAS评分改善率与PANSS阳性评分改善率、术前PANSS子项被害评分呈明显正相关(P＜0.05),而与PANSS子项交谈缺乏自发性和流畅性评分、不合作评分以及年龄呈明显负相关(P＜0.05).结论 ALIC-RSF对难治性SCZ的攻击行为有确切疗效,可明显提高病人的社会功能和生活质量.

Objective:To investigate the effects and mechanism of sciadopitysin combined with CK2 inhibitor CX-4945 on proliferation and apoptosis of glioblastoma U87 cells.Methods:Glioblastoma U87 cells were cultured in vitro, and treated with 0.01, 0.10, 1.00, 10.00, 100.00 μmol/L of sciadopitysin respectively. U87 cells were treated with 1.25, 2.50, 5.00, 10.00, 20.00 μmol/L of CX-4945. U87 cells were divided into control group (without any treatment), sciadopitysin group (100.00 μmol/L of sciadopitysin), CX-4945 group (5.00 μmol/L of CX-4945), sciadopitysin combined with CX-4945 group (100.00 μmol/L of sciadopitysin plus 5.00 μmol/L of CX-4945). MTT method was used to detect cell viability, Caspase3/7 activity assay and Annexin Ⅴ/ PI double staining were used to detect cell apoptosis, and Western blotting was used to detect the expressions of Notch1 pathway related proteins ICN1, HES1 and DLL3. Results:The cell viabilities of U87 cells treated with 0, 0.01, 0.10, 1.00, 10.00, 100.00 μmol/L of sciadopitysin were (100.00±6.30) %, (112.02±7.63) %, (140.84±6.73) %, (113.92±7.92) %, (102.60±7.12) % and (73.16±2.74) % respectively, and there was a statistically significant difference ( F=55.21, P<0.001). There were statistically significant differences in the cell viabilities of U87 cells between 0 μmol/L and 0.01, 0.10, 1.00, 100.00 μmol/L of sciadopitysin treatment ( P=0.009; P<0.001; P=0.003; P<0.001). The cell viability of U87 cells was inhibited by 100.00 μmol/L of sciadopitysin, while sciadopitysin at other low concentrations manifested as enhancement or no obvious effect. The cell viabilities of U87 cells treated with 0, 1.25, 2.50, 5.00, 10.00, 20.00 μmol/L of CX-4945 were (100.00±5.53) %, (108.70±10.24) %, (93.14±2.82) %, (81.46±4.92) %, (56.92±3.99) % and (31.24±2.67) % respectively, and there was a statistically significant difference ( F=135.18, P<0.001). There were statistically significant differences in the cell viabilities of U87 cells between 0 μmol/L and 1.25, 5.00, 10.00, 20.00 μmol/L of CX-4945 treatment ( P=0.022; P<0.001; P<0.001; P<0.001). Low concentration (1.25 μmol/L) of CX-4945 enhanced the cell viability of U87 cells, however higher concentrations (5.00, 10.00, 20.00 μmol/L) of CX-4945 shown inhibitory effect. The cell viabilities of U87 cells in the control group, sciadopitysin group, CX-4945 group and sciadopitysin combined with CX-4945 group were (100.00±5.53) %, (71.96±2.10) %, (77.66±4.12) % and (42.56±4.22) % respectively, and there was a statistically significant difference ( F=160.56, P<0.001). There were statistically significant differences between the control group and each treatment groups (all P<0.001). There were statistically significant differences between the sciadopitysin combined with CX-4945 group and sciadopitysin group, CX-4945 group (both P<0.001). The Caspase3/7 activities of U87 cells in the above four groups were 2.34±0.47, 4.02±0.22, 3.67±0.32 and 5.85±0.28 respectively, and there was a statistically significant difference ( F=55.80, P<0.001). The apoptosis rates of each groups were (0.40±0.10) %, (17.37±0.57) %, (3.00±0.66) % and (33.47±0.87) % respectively, and there was a statistically significant difference ( F=1 822.18, P<0.001). Further pairwise comparison showed that there were statistically significant differences in Caspase3/7 activities and apoptosis rates between the control group and each treatment groups ( P<0.001, P=0.001, P<0.001; P<0.001, P=0.001, P<0.001). There were statistically significant differences in Caspase3/7 activities and apoptosis rates between the sciadopitysin combined with CX-4945 group and sciadopitysin group, CX-4945 group (all P<0.001). The protein expression levels of Notch 1 pathway related proteins ICN1 (0.55±0.07 vs. 1.01±0.09), HES1 (0.66±0.08 vs. 1.00±0.06) and DLL3 (0.74±0.04 vs. 1.01±0.09) in U87 cells decreased significantly after treatment with 100.00 μmol/L of sciadopitysin ( t=5.94, P=0.004; t=5.15, P=0.007; t=4.00, P=0.016) . Conclusion:Sciadopitysin can synergize with CK2 inhibitor CX-4945 to inhibit the proliferation and promote apoptosis of glioblastoma U87 cells by inhibiting Notch1 signaling pathway.

目的 探讨MRI影像组学模型预测脑胶质瘤IDH-1基因突变和Ki-67表达水平的价值.方法 回顾性分析2017年1月至2021年6月经术后病理证实的77例胶质瘤的临床资料,其中72例IDH-1基因检测结果完整(IDH-1组),75例Ki-67检测结果完整(Ki-67组).基于MRI T2WI序列选择感兴趣区域,运用Python提取影像组学特征,先用两独立样本t检验进行筛选,再用LASSO回归进一步筛选特征值.使用随机森林和参数优化后的支持向量机两种分类器建立影像组学模型,绘制受试者工作特征曲线,并计算曲线下面积判断模型预测IDH-1基因突变和Ki-67表达水平的灵敏度、特异度.结果 IDH-1组t检验筛选出47个特征,再通过LASSO回归筛选出11个特征.Ki-67组t检验筛选出17个特征,再通过LASSO回归筛选出10个特征.支持向量机和随机森林两种方法建立的影像组学模型预测胶质瘤IDH-1基因突变和Ki-67表达水平均有较高的预测效能,预测准确率均超过88.0％.结论 MRI影像组学模型对预测胶质瘤IDH-1基因突变和Ki-67表达水平具有较高的应用价值,为胶质瘤术前预测提供了新思路.

目的 探讨经Dolenc入路手术治疗海绵窦肿瘤的疗效.方法 回顾性分析2013年1月到2020年6月经Dolenc入路手术切除的60例海绵窦肿瘤的临床资料.结果 肿瘤全切除36例,次全切除9例,大部分切除15例.术后病理显示55例(91.7％)为良性肿瘤,其中脑膜瘤27例,神经鞘瘤12例,垂体腺瘤12例.术后随访半年,颅神经损伤好转率为52.9％(27/51),术后头疼缓解率为85.7％(6/7),面部麻木好转率仅为33.3％(6/18).术后新发神经受损症状40例,其中眼神经麻痹22例(56％,22/40),随访6个月好转16例(72.7％,16/22).术后视力、视野好转率为50％(7/14);新发视力受损2例,随访6个月无明显改善.多因素logistic回归分析显示肿瘤包绕颈内动脉是肿瘤未全切除的独立危险因素(P＜0.05).结论 海绵窦肿瘤多数为良性肿瘤,Dolenc入路手术切除肿瘤效果良好,但颈内动脉被肿瘤包绕不利于全切除肿瘤.

Glioblastoma is the most common malignant tumor of the brain. Despite advances in treatment, the prognosis for the condition has remained poor. Glioblastoma is often associated with peritumoral brain edema (PTBE), which can result in increased intracranial pressure and devastating neurological sequelae if left untreated. Surgery is the main treatment for glioblastoma, however current international surgical guidelines do not specify whether glioblastoma-induced PTBE tissue should be resected. In this study, we analyzed treatment outcomes of PTBE using surgical resection. We performed a retrospective analysis of 255 cases of glioblastoma between 2014 and 2016, and found that a significant proportion of patients had a degree of PTBE. We found that surgical resection led to reduction in midline shift that had resulted from edema, however, postoperative complications and KPS scores were not significantly different in the two conditions. We also observed a delay in glioblastoma recurrence in patients undergoing PTBE tissue resection vs patients without resection of PTBE tissue. Interestingly, there was an abnormal expression of tumor associated genes in PTBE, which has not been previously been found. Taken together, this study indicates that glioblastoma-induced PTBE should be investigated further particularly as the tumor microenvironment is a known therapeutic target and therefore interactions between the microenvironment and PTBE should be explored. This study also highlights the importance of resection of PTBE tissue to not only reduce the mechanical obstruction associated with edema but also to delay recurrence of glioblastoma.

目的:调查湖北省神经外科医疗资源配置的基本情况，从而探讨神经外科医疗资源的分布特点及存在的问题。方法:在湖北省神经外科医疗质量控制中心的框架下，以问卷调查和访谈相结合的形式，对湖北省241家卫生医疗机构中开展神经外科工作的基本情况进行调查统计，收集医院建设、人才培养、学科建设等相应指标的数据，进行汇总、整理和横断面分析研究。调查时间为2019年9—11月。结果:湖北省241家卫生医疗机构中，有195家(80.91%)医院设立神经外科，其中三级医院87家(44.62%)，二级医院108家(55.38%)。湖北省共有神经外科编制床位10 209张，其中普通床位8 710张(85.32%)，重症监护室(ICU)床位1 499张(14.68%)；共有50个神经外科专科ICU 。武汉市神经外科专科床位数最多，为2 651张(25.97%)。湖北省共有神经外科医生1 697人，护士3 725人；武汉市拥有神经外科医生507人(29.88%)，专科护士1 126人(30.23%)。湖北省有1个国家级重点专科(位于武汉市)，6个博士学位培养基地，5个博士后流动站，博士学位培养基地和博士后流动站主要分布于重点高校的附属医院及军区总医院，且均在武汉市。结论:湖北省神经外科总体医疗资源丰富，优质资源主要集中于武汉市等大城市，个别城市神经外科发展滞后。

BACKGROUND:Therapeutic hypothermia (TH) has been proven to be protective in ischemic stroke (IS) due to its anti-inflammatory capacity. Recently, the interferon regulatory factor 4 (IRF4) has been characterized as a central regulator of neuroinflammation in IS. Here we aim to determine whether IFR4 contributes to the neuroprotective effects of TH in IS.METHODS:In the present study, IRF4 knockout (IRF4-/-) and wild-type (IRF4+/+) mice were treated with or without TH after IS. Cerebral IRF4 expression, the production of pro-inflammatory and anti-inflammatory cytokines and macrophage polarization were determined at 8 hours after reperfusion. In addition, cerebral infarct volume and neurological function were evaluated at 7 days after IS.RESULTS:TH attenuates IS together with enhanced IRF4 expression as well as reduced production of pro-inflammatory cytokines. In addition, TH increased M2 macrophage polarization while inhibited M1 macrophage polarization. However, IRF4 knockout worsens neurological outcomes of stoke mice. The expression of pro-inflammatory cytokines were markedly increased in IRF4-/- mice as compared with IRF4+/+ mice at 8 h after stroke. Moreover, IRF4 knockout driven the macrophage polarization toward M1phenotype at 8 h after stroke. Most importantly, IRF4 knockout abolished the neuroprotective and anti-inflammatory effects of TH in IS.CONCLUSION:Together, we report for the first time that TH attenuates neuroinflammation following IS by modulating M1/M2 macrophage polarization through the upregulation of IRF4 expression.

Stroke is a disease that occurs due to a sudden interruption of the blood supply to the brain. It is a leading cause of death and disability worldwide. It is well-known that the immune system drives brain injury following an episode of ischemic stroke. The innate system and the adaptive system play distinct but synergistic roles following ischemia. The innate system can be activated by damage-associated molecular patterns (DAMPs), which are released from cells in the ischemic region. Damaged cells also release various other mediators that serve to increase inflammation and compromise the integrity of the blood-brain barrier (BBB). Within 24 h of an ischemic insult, the adaptive immune system is activated. This involves T cell and B cell-mediated inflammatory and humoral effects. These cells also stimulate the release of various interleukins and cytokines, which can modulate the inflammatory response. The adaptive immune system has been shown to contribute to a state of immunodepression following an ischemic episode, and this can increase the risk of infections. However, this phenomenon is equally important in preventing autoimmunity of the body to brain antigens that are released into the peripheral system as a result of BBB compromise. In this review, we highlight the key components of the adaptive immune system that are activated following cerebral ischemia.

Stroke is a disease that occurs due to a sudden interruption of the blood supply to the brain. It is a leading cause of death and disability worldwide. It is well-known that the immune system drives brain injury following an episode of ischemic stroke. The innate system and the adaptive system play distinct but synergistic roles following ischemia. The innate system can be activated by damage-associated molecular patterns (DAMPs), which are released from cells in the ischemic region. Damaged cells also release various other mediators that serve to increase inflammation and compromise the integrity of the blood–brain barrier (BBB). Within 24 h of an ischemic insult, the adaptive immune system is activated. This involves T cell and B cell-mediated inflammatory and humoral effects. These cells also stimulate the release of various interleukins and cytokines, which can modulate the inflammatory response. The adaptive immune system has been shown to contribute to a state of immunodepression following an ischemic episode, and this can increase the risk of infections. However, this phenomenon is equally important in preventing autoimmunity of the body to brain antigens that are released into the peripheral system as a result of BBB compromise. In this review, we highlight the key components of the adaptive immune system that are activated following cerebral ischemia.

BACKGROUND:Cavernous hemangioma of the orbit is a benign tumor mostly located behind the eye globe, but it rarely spread into the brain, which is called cerebral cavernous malformation as well, the lesion in the brain is irregular and enlarged blood. Here we report one particular case of craniorbital cavernous hemangioma.CASE PRESENTATION:A 53-year-old woman presented with exophthalmos of the right eye and reduced vision. Computerized tomographical (CT) scan showed osteolytic honeycomb radial changes of the outer plate of the skull. A magnetic resonance imaging (MRI) scan was performed to obtain further details. T1-weighted (T1W) imaging showed slightly low signal mixed with small patchy high signal. T2-weighted (T2W) imaging showed uneven high signal. There was obvious enhancement in the middle and no enhancement in the peripheral bars. A surgically manage was performed using a left frontotemporal approach, the tumor excised fully, and the histopathology results revealed a cavernous hemangioma. The patient recovered well in the follow-up. Post-operative CT scan identified the lesion was successfully resected, MRI scan also showed full resection and enhanced signal from the presence of fat.CONCLUSIONS:Craniorbital cavernous hemangioma is uncommon, however within the cranium, they can lead to numerous complications particularly if affecting the visual apparatus. it could be diagnosed by imaging, which CT scan shows osteolytic honeycomb radial changes of the outer plate of the skull, T1W imaging shows slightly low signal mixed with small patchy high signal, T2W imaging shows uneven high signal, it is obvious enhancement in the middle and no enhancement in the peripheral bars. The surgically manage is the ideally treatment when there are some symptoms.

Objective: To explore the clinical application of lumbar cerebrospinal fluid drainage (LCFD) during the perioperative period in the department of neurosurgery.Methods: We retrospectively analyzed the clinical data of 59 patients undergone LCFD during the perioperative period and summarize the indication and clinical experience.Results: LCFD could anticipate the effect of ventriculoperitoneal shunt before surgery, decrease intracranial pressure in surgery, which showed good curative effect in the aneurysmal subarachnoid hemorrhage, postoperative cerebrospinal fluid leakage, postoperative in-tracranial infection and subdural collection of fluid after craniotomy. No pneumocephalus, intracranial hemorrhage or intracranial infection occured. Paradoxical herniation was provoked in one patient with craniectomy and then recovered after treatment.Conclusion: The application of LCFD during the peri-operative period in the department of neurosurgery is effective and safe.

Subarachnoid hemorrhage (SAH) is a form of stroke associated with high mortality and morbidity. Despite advances in treatment for SAH, the prognosis remains poor. We have previously demonstrated that glycine, a non-essential amino acid is involved in neuroprotection following intracerebral hemorrhage via the Phosphatase and tensin homolog (PTEN)/protein kinase B (AKT) signaling pathway. However, whether it has a role in inducing neuroprotection in SAH is not known. The present study was designed to investigate the role of glycine in SAH. In this study, we show that glycine can reduce brain edema and protect neurons in SAH via a novel pathway. Following a hemorrhagic episode, there is evidence of downregulation of S473 phosphorylation of AKT (p-AKT), and this can be reversed with glycine treatment. We also found that administration of glycine can reduce neuronal cell death in SAH by activating the AKT pathway. Glycine was shown to upregulate miRNA-26b, which led to PTEN downregulation followed by AKT activation, resulting in inhibition of neuronal death. Inhibition of miRNA-26b, PTEN or AKT activation suppressed the neuroprotective effects of glycine. Glycine treatment also suppressed SAH-induced M1 microglial polarization and thereby inflammation. Taken together, we conclude that glycine has neuroprotective effects in SAH and is mediated by the miRNA-26b/PTEN/AKT signaling pathway, which may be a therapeutic target for treatment of SAH injury.

Hypoxic Ischemic Encephalopathy (HIE) is a type of neonatal brain injury, which occurs due to lack of supply and oxygen deprivation to the brain. It is associated with a high morbidity and mortality rate. There are several therapeutic strategies that can be used to improve outcomes in patients with HIE. These include cell therapies such as marrow mesenchymal stem cells (MSCs) and umbilical cord blood stem cells (UCBCs), which are being incorporated into the new protocols for the prevention of ischemic brain damage. The focus of this review is to discuss the mechanism of oxidative stress in HIE and summarize the current available treatments for HIE. We hope that a better understanding of the relationship between oxidative stress and HIE will provide new insights on the potential therapy of this devastating condition.

目的 探讨额颞硬膜外-下入路手术切除海绵窦侵袭性垂体腺瘤的效果.方法 回顾性分析2014年7月至2016年12月采用额颞硬膜外-下入路显微手术治疗的58例海绵窦侵袭性垂体腺瘤的临床资料.结果 肿瘤全切除46例,次全切除12例;术后出现动眼神经麻痹46例,其中42例0.5～1年后恢复.无死亡病例.结论 额颞硬膜外-下入路显微手术是治疗海绵窦侵袭性垂体腺瘤有效的方法,动眼神经麻痹是主要并发症.

In order to improve medical students' cognition of neurosurgery specialty and clinical practice,and cultivate students' self-learning ability,the model of flipping classroom combined with problem based learning was applied in clinical teaching in our department.The experimental group adopted flip classroom combined with PBL which penetrated the pre-class teaching design,classroom activity design,after-class summary and teaching feedback,while the control group adopted the traditional teaching method.The evaluation results showed that the students in the experimental group had significantly higher scores in-class knowledge and examination results than those in the control group.In addition,students had a high degree of recognition and satisfaction with the newly combined teaching model.The combination of flipped classroom and PBL teaching method could make up their deficiency,complement each other to achieve the best clinical teaching effect and improve students comprehensive ability.Meanwhile it puts forward new requirements for students and teachers,during which teachers need to be fully prepared and update teaching concepts for the sake of fulfilling the mutual promotion of teaching and learning.

Objective To evaluate the curative effect of different surgical forms on the pituitary adenomas, and their indications, merits and demerits. Methods The clinical data of 116 patients with pituitary adenomas, who underwent surgery from February, 2011 to October, 2017, were analyzed retrospectively. Of 116 patients with pituitary adenomas, 85 were treated by transnasal transphenoidal microsurgery, 24 by microsurgery via pterional approach, 4 microsurgery via right supercillary arche key hole approach and 3 by microsurgery via longtudinal approach. Results The pituitary adenomas were totally resected in 92 patients, subtotally in 20, in great part in 3 and partly in 1. Conclusions The surgical outcomes are good in these 116 patients. The pituitary adenomas confined to the sella and parasellar regions should be removed by microsurgery through transnasal transsphenoidal approach. But the invasive pituitary tumors should be by individualized microsurgery selected according to their characteristics on the images.