Objective:To investigate the efficacy of microsurgical treatment in cavernous sinus tumors.Methods:The clinical data of 87 patients with cavernous sinus tumor treated by microsurgery from January, 2010 to August, 2019 were analysed retrospectively. The surgical approaches and microsurgical skills for common tumors in Cavernous Sinus region were discussed. The follow-up included outpatient and telephone follow-ups, and the follow-up results were evaluated by KPS score.Results:Among the 87 cases, 57 were totally resected (65.5%), 14 were subtotal resected (16.1%) and 16 were major resected (18.4%). Hospitalisation ranged from 14 to 98 days, with an average of 29 days. Postoperative complications occurred in 30 cases with cranial nerve injury, 2 brain stem injury, 4 postoperative bleeding, 5 cerebrospinal fluid leakage, 4 infection, 1 Pituitary damage and 1 death. Prognosis and follow-up analysis showed 68 cases with KPS>60 and 66 with KPS>80 at 1 month after surgery; 74 with KPS>70 and 72 with KPS>80 at 3 months after surgery; 78 with KPS>80 by 12 months after surgery. During the follow-up period of 6-120 months, 3 cases died. Recurrence: 6 of incomplete resection of meningioma, were in 1-6 years after the surgery, 4 of incomplete resection of schwannoma in 1-8 years, 2 of pituitary adenoma respectively in 13 and 16 months after the surgery. There was no recurrence after reoperation. Two cases of chondrosarcoma, 3 of chordoma and 3 of germinoma were treated with radiotherapy, and during the follow-up, there was no progress of the focus. No tumor progression or recurrence was found in other cases during follow-up.Conclusion:Surgery of cavernous sinus tumor is difficult due to frequent postoperative complications. Reasonable preoperative plan, surgical approach and precise microsurgical techniques are the keys in reduction of postoperative complications and in the improvement of prognosis.

Objective:To evaluate the value of intraoperative magnetic resonance imaging (iMRI) combined with neuronavigation for the resection of insular gliomas.Methods:From August 2014 to October 2017 in the First Hospital Affiliated to Sun Yat-sen University,clinical data of 41 patients with insular glioma,who underwent the surgery assisted with 3.0T iMRI and neuronavigation,were analyzed retrospectively,and the resection extent,complications and prognosis were evaluated.Results:Subtotal tumor resection was achieved in 21 patients and partial resection was done in 20 after iMRI scanning.After further resection,total tumor resection was achieved in 16 patients,subtotal resection in 18 and partial resection in 7.There was a statistical significant difference in tumor resection between pre-iMRI and post-iMRI according to the Fisher test (P＜0.05).In the follow-up from 3 months to 3 years,the symptoms of the 41 patients had improved.Conclusion:iMRI corrected the shift of brain.Neuronavigation can accurately and timely assess the degree of resecting tumor.The combination of neuronavigation with surgery can maximally and safely resect insular glioma.

Objective The present study was to investigate the feasibility of use of high resolution magnetic reso?nance vessel wall imaging(HR-VWI)in evaluation of intracranial aneurysms. Methods We prospectively collected data from patients who had intracranial aneurysms and received HR-VWI scan before surgical treatment or conservative treatment. Aneurysms were divided into ruptured group (n=12) and unruptured group (n=88). Aneurysm site, size, neck, aspect ratio(AR), daughter sac and aneurysmal wall enhancement scale were analyzed in both groups. Univariate and multivariate Logistic regression were performed to evaluate the risk factors of aneurysm rupture. Subgroup analysis was also performed to study symptomatic and asymptomatic unruptured aneurysms. Results Aneurysm size(t=2.187,P=0.031),AR(t=3.164,P=0.002),incidence of daughter sac(P=0.012) and aneurysmal wall enhancement scale(P<0.001)were higher in ruptured aneurysm group. Multivariate Logistic regression showed that aneurysmal wall enhance?ment scale was the only independent risk factor of ruptured aneurysms(P=0.002). Subgroup analysis showed aneurysm wall enhancement scale(P<0.001) and AR(t=3.939,P<0.001) were higher in symptomatic unruptured aneurysms. Conclusion Aneurysm wall enhancement on HR-VWI is more frequently seen in ruptured aneurysms and symptomatic unruptured aneurysms. Histological study is needed for better understanding of the mechanism of aneurysm wall enhance?ment.

Objective To study the influence of conflict vessels of trigeminal neuralgia (TN) in microvascular decompression (MVD) efficacy.Methods The clinical data of 86 patients accepted MVD for TN,admitted to our hospital from July 2008 to August 2012,were retrospectively analyzed.According to the number of offending vessels under intranperative microscope,the patients were divided into single offending vessel group and multi-offending vessels group;the clinical features,distributions of offending vessels,imaging results and surgical findings of the two groups were compared.Results Forty-nine patients (57.0％) were enrolled to single offending vessel group,and 37 (43.0％) were enrolled to multi-offending vessels group;ratio of offside pain was higher than that of left side in both two groups.Conflict vessels in the single offending vessel group mainly were superior cerebellar artery (SCA,n=29,59.2％) and anterior inferior cerebellar artery (AICA,n=19,38.8％);conflict vessels in the multi-offending vessels group mainly were SCA+AICA (n=21,56.8％) and SCA+ petrosal vein (n=8,21.6％).Follow-up at 6 months after the operation showed an efficient outcome of 96.5％:the effective rate of single offending vessel group was 98.0％ while that of multi-offending vessels group was 94.6％ with significant difference(x2=0.003,P=0.958).No mortality or severe complications,such as hearing loss,cerebellar bleeding or cerebellar infarction,were recorded.Conclusions MVD is a safe and effective treatment for TN.MVD on multiple conflict vessels TN and that on single conflict vessel TN have approximate efficacy.

Objective We evaluate if supplementary grading system can refine patient selection and accurately predict neurological outcome in BAVM. Methods We retrospectively study 221 BAVM patients who were treated micro?surgically by our hospital. The score of pre and post operation mRS and relative clinical, radiology data were collected. Two different logistic models (Spetzler-Martin, Supplementary Spetzler-Martin grading model) were constructed to com?pare the area under ROC. Results Some factors are significant different between worse outcome patients and good out?come patients:Non-hemorrhagic presentations prior surgery, AVM bigger than 3cm, diffuse shape of AVM and the elder patients. Predictive accuracy was higher for the supplementary model (ROC area, 0.91), than the Spetzler-Martin model (ROC area, 0.774). So the predictive accuracy of supplementary model was significantly better than that of the Spet?zler-Martin model (P=0.0362). Conclusions Supplementary Spetzler-Martin model can improve preoperative risk pre?diction and subgroup the patients more efficiently. When the score less than 5(including 5) in supplementary Spet?zler-Martin patients seem to have lower risk relative to surgery.

Objective To observe the effect of ADM3100 on angiogenesis in rat models of cerebral chronic hypoperfusion (CCH) and its mechanism.Methods Thirty-six healthy female SD rats,weighting 200-250 g,were randomly divided in normal control group,CCH+AMD3100 group and CCH+saline group (n=12);rats in the CCH+AMD3100 group and CCH+saline group underwent end-to-side anastomosis between the left distal external jugular vein (EJV) and the ipsilateral common carotid artery,followed by ligation of the right vein draining the transverse sinus and bilateral external carotid arteries,and then,they were received intraperitoneal injection of 5 mg/ (kg·d) ADM3100 and physiological saline,respectively,for a consecutive 30 d.Rats were then scarified;microvessel density (MVD) was assessed based on immunohistochemistry of CD34,numbers of CXCR4 and CD45 double positive cells were confirmed by double immunofluorescence,and matrix metalloproteinases-9 (MMP-9) was evaluated by Western blotting.Results MVD was 61.82±19.83/mm2,89.50±23.61/mm2 and 121.70 ±31.12/mm2 in the normal control group,CCH+AMD3100 group and CCH+saline group,respectively;numbers of CXCR4 and CD45 double positive cells were 3.47±2.63,7.58±4.49 and 12.33± 6.11 per high power field (×200) in normal control group,CCH+AMD3100 group and CCH+saline group,respectively;significant differences between groups were noted (P＜0.05).As compared with the expression of MMP-9 in the normal control group,that in the CCH+AMD3100 group and CCH+saline group was significantly increased (0.009±0.003,0.151 ±0.058 and 0.325 ±0.068,P＜0.05).As compared with CCH+saline group,CCH+AMD3100 group had significantly smaller MVD and numbers of CXCR4 and CD45 double positive cells and lower MMP-9 level (P＜0.05).Conclusion AMD3100 will decrease angiogenesis in rat models of cerebral chronic hypoperfusion,which may be associated with inhibiting CXCR4+ CD45+ cells infiltration into cerebral tissue by blocking stromal cells-derived factor-1 α/CXCR4 signaling.

Objective To evaluate the clinical application of multimodality treatment of brain arteriovenous malformation (BAVM) with Onyx embolization and microsurgery.Methods There were 48 patients with BAVM treated by combination of Onyx embolization and microsurgery.The clinical features,therapeutic process,complications and discharge status (by MRI,DSA and Glasgow outcome scale,GOS) were recorded in detail.The prognosis was estimated by modified Rankin scale (mRS) with 6-42 months' follow-up.Results The total resection rate was 97.9％.The therapy-related complications happened in 8 patients (16.7％).Among them,4 cases had dysfunction of central nervous system (8.3％),2 cases with intra-cerebral hemorrhage (4.2％),and 2 suffered from severe cerebral edema (4.2％).Good recovery was seen in 38 cases (79.2％) evaluated by GOS when discharged from hospital.The follow-up result mRS ＜ 3 was 97.9％.Conclusion Multimodality treatment of BAVM with Onyx embolization and microsurgery should be a good therapeutic strategy.

Objective To investigate the expressions ofstromal-cell derived factor-1α (SDF-1α)and its receptor CXCR4 in brain arteriovenous malformation (AVM) and to explore the relationships of SDF-1α with hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF).Methods Surgical specimens from 48 patients accepted brain AVM resection,collected in our hospital from January 2012 to December 2013,were studied for expressions ofSDF-1α,CXCR4,VEGF and HIF-1α by immunohistochemical staining.The relationships of SDF-1α with VEGF and HIF-1α were analyzed and influences of embolism,hemorrhage and Spetzer-Martin classification in SDF-1α expression were assessed.Results SDF-1α and CXCR4 expressed in 100％ and 83.3％ AVM specimens,respectively.The positive staining for SDF-1α was observed in the cytoplasm of vascular endothelium within the nidus and smooth muscle cells of vascular wall.CXCR4 expressed in vascular endothelium and perivascular cells located in the space between the abnormal vessels.SDF-1α expression was significantly associated with VEGF and HIF-1α (r=0.537 and 0.437,respectively,P＜0.05).SDF-1α showed more intense expression in embolized patients than that in non-embolized patients (P＜ 0.05),while no significant difference was noted between patients with and without hemorrhage and between patients of different Spetzer-Martin classifications (P＞0.05).Conclusion SDF-1α and its receptor CXCR4 highly express in brain AVM; preoperative embolization might induce expression of SDF-1α.

Objective T0 investigate the effects of transforming growth factorβ1 ( TGFβ1 ) and its receptorβ2 (TGFβR2) gene single nucleotide polymorphisms on the risk of intracranial hemorrhage in patients with brain arteriovenous malformation (BAVM).Methods Fifty-three BAVM patients of both sexes aged 18-64 yr who were genetically unrelated native HAN of Guangdong province were divided into 2 groups:patients with and without intracranial hemorrhage ( n =30:23).Venous blood samples were collected and anti-coagulated with ethylene diaminetetraacetic acid for genomic DNA extraction.TGFβ1-509C/T (rs1800469) and TGFβR2 875A/G (rs3087465) gene SNPs were genotyped by using PCR-RFLP.Results There were no significant differences in genotype and frequency between the 2 groups.The G carrier frequency of the TGFβR2 genotype was significantly higher in patients with intracranial hemorrhage than in patients without intracranial hemonrhage.The G carrier of the TGFβR2 genotype was associated with intrarcranial hemorrhage in patients with BAVM.Conclusion TGFβ1 gene polymorphism is not relevant to the intracranial hemorrhage in patients with BAVM,but polymorphisms of TGFβR2 could be a risk factor.

Objective To perform facial nerve monitoring in patients under the low level of neuromuscular blockade during resection of acoustic neurinomas.Methods Twenty-eight patients with large,or medium acoustic neuroma underwent the surgery of acoustic neurinomas resection. During the operation,TOF and EEG monitoring were performed in order to detect the degree of muscle relaxation and the depth of anesthesia. Neuromuscular relaxation was maintained at T_4/T_1=25%～50% by adjusting doses of muscle relaxant and aneasthetic. Free-run EMG and Triggered EMG of orbicularis oris, orbicularis oculi, masseter and trapezius were recordered to monitor the function of the facial, trigeminal and accessory nerves, respectively. The function of the facial nerve was evaluated at first week and half year postoperatively according to House-brackmann classification.Results The facial never was successfully identified and mapped by neurominitoring in all 28 patients. successfully, tThe electrical stimulation was 0.1 mA-0.3 mA and no any involuntary body movement was observed in all patients ne of patients have moved during operation. The preservation of the facial nerve function following surgery was good. Five patients had a HB grade I, 13 a HB grade II, 8 a grade III and 2 a HB grade IV The facial nerve function was HB Grade Ⅰin 5 of 28 patients, HB GradeⅡ in 13, HB Grade Ⅲ in 8 and HB Grade Ⅳ in 2 immediately after operation. Six months after surgery, 10 casespatents showed demonstrated a HB GradeⅠof facial never function, 12 cases exhibited a slight palsy (HB Grade II) , and 5 cases exhibited a HB Grade III palsy and . Another 1 cases a exhibited severe palsy (HB Grade IV).Conclusions Facial nerve monitoring in patients under the low level of neuromuscular blockade can ensure the surgical safety and preserve the facial never function.