Objective To determine pathogenesis and the suitable time of operation for myelomeningocele associated with hydrocephalus in neonate.Methods 6 underwent head CT scanning, 2 lumbosacral CT scanning and 6 lumbosacral X radiography on 6 patients myelomeningocele complicated with hydrocephalus.Ventriculoperitoneal shunt and repair of the myelomeningocele were performed respectively for one patient.from 1 day to 28 day old.Operation stage 1 in 5 patients.Repair of the myelomeningocele concurred with ventriculoperitoneal shunt. Intracranial pressure was measured in shunting procedure.Results 4 patients had normal intracranial pressure,2 patients increased intracranial pressure in the 6 patients.The volume of the hernial sac had markedly diminished and status of hernial sac had greatly improved wall in the patient who wnderwent two-stage procedures after shunt procedure. Lumbosacral wound healing was good . No recurrent myelomeningocele was found, no hydrocephalus was seen using head CT scanning and clinical manifestation has improved in these patients who were followed up 6 month to 3 year.Conclusions Hydrocephalus may deteriorate the degree of lumbosacral myelomeningocele. Effecacy of vntriculoperitoneal shunt and repair of the myelomeningocele was excellent in myelomeningocele complicated with hydrocephalus in neonate.Micro-operative technique might prevent the occurrence of tethered cord.

Objective To explore the peripheral blood T lymphocytes cell level in different grades of cerebral gliomas pa-tients at the time of before and after operation and its clinical significance .Methods A total of 80 cases of brain tumor patients from February 2010 to February 2012 in this hospital were chosed as study objects ,included 57 cases of glioma ,23 cases of other brain tumors ;57 cases of glioma were divided into 19 cases of low grade group and 38 cases of high grade group accorded to WHO grading standards ,and 50 cases of healthy people in same period were selected as control group .Venous blood in three groups were extracted at 1st day and 1st week after operation ,to detected the level of T lymphocyte subsets in peripheral blood and analyze the relationship between the different grade gliomas and prognosis .Results The peripheral blood CD3 + ,CD4 + ,CD4 + /CD8 + in control group were significantly higher than that of other brain tumor group and the glioma group ,CD8 + was significantly lower than that of the two groups(P< 0 .05) .Compared with other tumor group ,peripheral blood CD3 + ,CD4 + ,CD4 + /CD8 + in glioma group de-creased significantly ,CD8 + increased significantly(P< 0 .05) ;before and after the operation ,the CD3 + and CD4 + /CD8 + levels were significantly higher in low grade group than in the high grade group ,CD8 + was significantly lower in low grade group than in the high grade group(P< 0 .05) ,at the time of 1st week after operation ,CD3 + and CD4 + /CD8 + increased ,CD8 + decreased significant-ly of two groups when intra-group comparison (P < 0 .05) .The median survival time were 31 months in low grade group and 13 months in high grade group ,and the singnificance was found in two groups(P< 0 .05) .The median survival time were 34 months in CD4 + /CD8 + > 1 group and 17 months in CD4 + /CD8 + < 1 group ,the singnificance was found in two groups(P< 0 .05) .Conclusion The immune function of patients with brain glioma is inhibited ,the higher the malignancy of the tumor ,the more obvious of im-mune inhibition ;T lymphocyte subsets level could be used as evaluating index of malignant degree and prognosis of brain glioma .

Objective To present our experience with management of craniopharyngiomas by endoscopic endonasal approach Methods A retrospective review of clinical data of 65 patients who were treated for craniopharyngiomas by endoscopic endonasal approach from February 2012 to May 2016. All patients were analyzed by treatment effect, complications, and follow-up result. Results Total removal of the tumors were completed in 52 cases (80.0%), subtotal removal in 11 cases (16.9%), and partial resection in 2 cases (3.1%). The pituitary stalks were identified in 57 cases when surgery, and severed in 41 cases (71.9%). Postoperative visual acuity was improved in 31 cases (47.7%), and 6 cases remained in the preoperative level, whereas worsening occurred in 1 case. Worsening of the anterior pituitary function was reported in 21 cases (32.3%). Transient diabetes insipidus after operation was occurred in 45 patients (69.2%), and long-term diabetes insipidus was occurred in 9 cases (13.8%). Postoperative cerebrospinal fluid (CSF) leak was occurred in 4 cases (6.2%), accompanied with intracranial infection, and all these cases were repaired under endoscope again, 3 cases were saved, but 1 case was dead. Perioperative mortality rate was 4.6%. 52 patients were followed up for 4.0 ~ 45.0 (mean, 20.8) months, and 44 patients (84.6%) returned life to normal. Obesity developed in 8 patients (15.4%), with 2 recurrent cases and no deaths during follow-up period. Conclusion The endoscopic endonasal approach is a safe and effective minimally invasive surgery approach for treating craniopharyngiomas, and has its own unique advantage.

Objective To describe the clinical features and surgical treatment outcomes of patients with moyamoya disease (MMD) in Jiangxi Province of China.Methods Clinical features of a total of 1223 patients with MMD accepted treatment in our hospital from January 2005 to December 2015 were retrospectively analyzed.Totally,228 patients with MMD accepted revascularization from November 2011 to November 2015;the surgical treatment outcomes were retrospectively analyzed.Results The ratio of male to female was 1:1.1 (580/643).The mean age was 45.1±12.2 years (ranged 3-79 years).Two definite peaks in age distribution were found (aged 4-10 and aged 38-51).High incidence was noted in Nanchang,Fuzhou,Yichun,and Shangrao.Ischemic symptoms appeared in children and intracranial hemorrhage appeared in adults;the majority of ischemic patients presented with transient ischemic attack,and in patients with hemorrhagic MMD,intraventricular hemorrhage was the most common type.Familial history was observed in only one patient.Totally 16 indirect and 232 combined revascularizations were performed in 248 hemispheres of 49 patients with hemorrlogic type MMD and 179 patients with ischemic type MMD.Perioperative complication was noted in 18 patients (7.9％).Follow-up showed that most patients had good prognosis.Conclusions There is no difference in the gender distribution of patients with MMD in Jiangxi province.Though two definite peaks in age distribution are found,the number of adult patients is larger than that of children,and primarily experiencing intracranial hemorrhage.There are few familial histories and regional concentration distribution.Individualized treatment with extra-intracranial revascularization is an effective treatment strategy for MMD.