Objective To investigate the changes of non-motor symptoms and quality of life in patients with Parkinson's disease (PD) after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). Methods Questionnaires were conducted among a convenience sample of 45 PD patients who met the indications of STN-DBS in the Functional Neurosurgery Center of Ruijin Hospital,Shanghai JiaoTong University School of Medicine in Shanghai from June 1,2020 to August 31,2020.The Non-motor Symptom Scale (NMSS) and 8-item Parkinson's Disease Questionnaire (PDQ-8) were used to evaluate the patients' non-motor symptoms and quality of life preoperatively and at 3,6,12 and 24-month postoperative visits. Results Generalized estimation equation analysis showed a significant overall change of PDQ-8 and levodopa equivalent daily dose (LEDD) over five follow-up visits ( P＜0.05).Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous subscores showed a statistically significant decreasing trend ( P＜0.05),while Cardiovascular and Perceptual subscores of NMSS were unchanged ( P>0.05). Conclusion Bilateral STN-DBS has a long-term benefit on sleep/fatigue and urinary symptoms and a short-term benefit on Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous symptoms in PD patients.Moreover,it can reduce the medication intake and improve the patients' quality of life.

Objective To analyze and investigate the postoperative clinical outcomes and recurrence of meningioma patients and their influencing factors. Methods Demographic,clinical,oncologic,and perioperative data of patients first diagnosed with meningioma at our hospital from January 2018 to February 2021 were retrospectively analyzed.Patients were followed up for a mean of 22.4 ± 9.6 months by telephone or outpatient,and patients were divided into two subgroups of good prognosis (0~3) and poor prognosis (>3) according to their mRS scores at follow-up.Multivariate logistic regression analysis was performed to determine the factors affecting the prognosis and recurrence of patients. Results The mean age of the 85 patients was 47 years,the ratio of female to male patients was 2:1,and 29 patients had a combined prior medical history.Among them,83.5% of the tumors were located in the supratentorial,82.4% of the tumors were >5 cm,85.9% underwent gross total resection (SM grade I-III),and 92.9% of the tumors were WHO pathologically graded as grade I.The follow-up results suggested that 92.9% of patients had a good prognosis and 5.9% of patients had recurrence.Multivariate logistic regression analysis showed that tumors <3 cm (OR=0.023,95% CI 0.001~0.518; P=0.009),gross total resection (OR=17.650,95% CI 4.761~61.026; P＜0.001) and medical comorbidities (OR=0.205,95% CI 0.014~0.837; P=0.002) were significant factors affecting prognosis,while age (OR=3.534,95% CI 1.293~11.851; P=0.028) and WHO pathological classification (OR=0.021,95% CI 0.001~0.324, P＜0.001) were significantly associated with tumor recurrence. Conclusion Most patients with meningioma had a good prognosis,and tumor size,extent of resection,age,tumor pathologic grade,and medical comorbidities were significantly associated with postoperative outcome and recurrence.

Objective To compare the safety and efficacy of transsphenoidal neuroendoscopic and microscopical resection of pituitary tumors. Methods 391 cases of pituitary tumor in our hospital from July 2019 to August 2021 were retrospectively analyzed,including 212 cases in the neuroendoscopy group and 179 cases in the microscope group.Operation time,intraoperative blood loss,length of stay,the rate of total removal of tumor,incidence of intraoperative cerebrospinal fluid leakage,occurrence of postoperative complications,improvement of postoperative visual field and related perioperative indicators were compared between the two groups. Results Compared with the microscope group,the operation time of patients in the neuroendoscopy group was significantly longer (129.66±49.66mins vs.76.87± 19.23mins,P< 0.001),and the total tumor resection rate in the two groups was not significantly abnormal (70.8% vs.63.7%, P=0.137).However,for Knosp III-IV patients,the total surgical resection rate was significantly higher in the neuroendoscopic group (67.1% vs.32.3%,P< 0.001).Intraoperative blood loss (67.33±19.95mL vs.62.21±15.45mL, P=0.082),postoperative hospital stay (4.65±1.31 days vs.4.31±1.24 days, P=0.237),the incidence of intraoperative high-flow cerebrospinal fluid leakage (4.7% vs.6.1%, P=0.533),intraoperative internal carotid artery injury (0.5% vs.0.6%, P=0.904),and postoperative recovery of pituitary-related hormone levels were not significantly different.The incidence of postoperative complications was low in both groups,and there was no statistical difference between the two groups,including: Postoperative cerebrospinal fluid rhinorrhea (0.9% vs.1.6%, P=0.558),intracranial infection (0.9% vs.1.1%, P=0.865),diabetes insipidus (4.2% vs.6.1%, P=0.533),and rebleeding (0.9% vs.1.1%, P=0.865).Postoperative visual field was significantly improved in both groups,but there was no significant difference in the rate of improvement between the two groups (77.9% vs.85.7%, P=0.170). Conclusion Bothtranssphenoidalneuroendoscopic and microscopic resection of pituitary tumors have satisfactory safety and efficacy.For patients with Knosp III-IV,whose tumors invading the cavernous sinus,neuroendoscopic surgery is more advantageous.

Objective To study the distribution characteristics of cerebral blood vessels in mice and the spatial relationship with adjacent nerve cells using fast three-dimensional microscopic imaging technology. Methods The adult Tie2-Cre::Ai9 hybrid transgenicmice(C57BL/6) with fluorescent protein labeled vascular endothelial cells were perfused with 4% paraformaldehyde in the heart to obtain complete brain tissue,clearing tissue,andstained the nerve cells of the whole brain.The rapid three-dimensional imaging system (VISoR) was used to obtain the microscopic images of the whole brain vessels and nerve cells in mice with 1×1×3.5 μm ³ voxel resolution,and the two-dimensional image sequence was reconstructed into a three-dimensional whole brain image.Part of cortex,hippocampus and thalamus were selected to segment and extract blood vessels and analyze their morphological characteristics;Automatically identify nerve cells and quantitatively analyze the distribution characteristics of the distance between nerve cells and the nearest blood vessels. Results The three-dimensional images of the distribution of blood vessels and nerve cells in the whole brain of mice were successfully collected.The whole brain view of C57BL/6 mouse's complex vascular network was provided through high-resolution brain atlas.The analysis showed that the density of bifurcation points and the volume fraction of blood vessels in hippocampus were smaller than those in cortex and thalamus,and the difference was statistically significant.The staining of neurons with Nissl stain showed that there were differences in the distribution of blood vessels and nerve cells in different brain regions.In the regions of interest of different brain regions,the distance between neurons and blood vessels was counted,and the results were statistically different. Conclusion The whole brain vessels and neurons of mice can be imaged by fast 3D microscopic imaging technology.Through the quantitative analysis of regional blood vessels and nerves,it was found that there were regional distribution characteristics between blood vessels and nerves in mice.

Objective To investigate the important factors affecting the early prognosis of patients over 75 years old after embolization of ruptured intracranial aneurysm. Methods A retrospective collection of 78 patients with intracranial aneurysm who were admitted to the Department of Neurosurgery of Xiamen Third Hospital from January 2016 to January 2022,all cases were over 75 years old,and relevant clinical data of embolization treatment,including gender,Weight,smoking history,hypertension,diabetes,hyperlipidemia,atrial fibrillation,cerebrovascular disease history,aneurysm location,Hunt-Hess classification,WFNSS classification,CT Fisher classification,etc.The prognosis results were divided into a good outcome group (mRS grade I-II) and a poor outcome group (mRS grade III-V) using the modified Rankin scale (mRS) scale.Statistical analysis of clinical data,screening of independent risk factors that affect the poor prognosis of patients. Results Tatistical univariate analysis showed that,compared with the good prognosis group,the higher the GCS grade,WFNSS grade and Hunt-Hess grade of the poor prognosis group,the worse the relative prognosis,and the difference was statistically significant ( P＜0.05).Logistic regression analysis showed that GCS classification (OR=1.024,95%CI:0.214~4.914, P=0.976),WFNSS classification (OR=9.021,95%CI:2.557~31.824, P=0.001) and Hunt-Hess classification (OR=6.848,95%CI:1.435~32.682, P=0.016) was a prognostic factor.ROC curve analysis showed that the combination of Hunt-Hess classification and WFNSS classification could be used as an important influencing factor for neurological recovery (AUC=0.855),When taking the best cut-off point,the sensitivity was 89.6% and the specificity was 70.0%. Conclusion For the short-term prognosis of ruptured intracranial aneurysm interventional embolization in people over 75 years old,the combination of Hunt-Hess classification and WFNSS classification is more valuable than other factors.

Objective To investigate the significance of the classification of vertebral artery in vertebral artery related hemifacial spasm,explore the strategies of microvascular decompression,improve the therapeutic effects and reduce the complications. Methods A retrospective study was performed to analyze the clinical data of 109 cases with microvascular decompression for vertebral artery related hemifacial spasm in our hospital.In these cases,the vertebral arteries were classified into four types by its movable space.Based on the surgical practice,the influence of the classification of vertebral artery on decompression process was evaluated and the security and difficulty of operation was analyzed.The surgical strategies were summed up according to the different four types of vertebral arteries. Results The microvascular decompression surgery for hemifacial spasm with vertebral artery was a safe and effective method.In 60.55% of cases,the vertebral artery can be moved ventrally at the level of posterior cranial nerves;In 23.85% of cases,the vertebral artery can only be moved at the facial nerve level;In 0.92% of cases,there was no movable space at the level of posterior cranial nerves and the facial nerve,which made the operation difficult;In 14.68% of the cases,the bilateral vertery arteries were highly deviated to one side,which made the offending vessels complex and difficult to recognize,so the relative position of the bilateral vertebral arteries should be changed firstly,in order to win the decompression space. Conclusion The classification of the vertebral arteries is significant in microvascular decompression for vertebral artery related hemifacial spasm,which can improve the operative outcome and reduce the incidence of postoperative complications.

Objective To investigate the relationship between serum miR-29b,Aquaporin-4 (AQP4) and disease progression,white matter hyperintensities (WMH) in elderly patients with acute lacunar infarction (ALI). Methods 128 elderly patients with ALI who were hospitalized in the department of Neurology of our hospital from January 2018 to December 2018 were selected as the research group,and 60 subjects with matched age and gender and without any cerebral infarction were selected as the control group.The expression of serum miR-29b was measured by real-time fluorescence quantitative PCR,and the level of serum AQP4 was measured by enzyme-linked immunosorbent assay.Early neurological dysfunction (END) was evaluated according to NIHSS scores on admission and after 7 days; the WMH volume was determined according to the Results of brain MRI scan within 7 days after admission; and the progress of cerebral microbleeds was judged by brain MRI after 1-year follow-up. Results Compared with the control group,the expression of miR-29b in the study group was lower,while the serum AQP4 level was increased ( P<0.05),and there was a negative correlation between the serum miR-29b and AQP4 level in ALI patients ( r=-0.791, P<0.001).The area under ROC curve of serum miR-29b for the diagnosis of ALI was 0.881 (95%CI:0.798~0.934),which was more than the AUC of serum AQP4 ( P<0.05).In addition,compared with the non-END subgroup ( n=96),the serum miR-29b expression was decreased and the serum AQP4 level was increased in the END subgroup ( n=32) ( P<0.05).Compared with WMH mild lesion subgroup( n=50),the serum miR-29b expression was decreased and serum AQP4 level was increased in severe lesion subgroup ( n=78) ( P<0.05).Compared with the no cerebral microbleeds progressive subgroup ( n=104),the serum miR-29b expression was decreased and the serum AQP4 level was increased in the progressive subgroup ( n=24) ( P<0.05). Conclusion The serum miR-29b expression is decreased,while serum AQP4 protein level is increased in elderly ALI patients,which would be related to the occurrence of END,the degree of WMH lesions and the progress of cerebral microbleeds in one year follow-up.Serum miR-29b would be a potential biomarker for early diagnosis of ALI.

Objective To observe the effect of 3D-slicer software combined with microscope small bone window operation on hypertensive basal ganglia intracerebral hemorrhage. Methods The clinical data of 66 patients with hypertensive basal ganglia intracerebral hemorrhage treated in our hospital from August 2019 to August 2021 were analyzed retrospectively.According to the treatment plan,they were divided into 3D-slicer software combined with microscope group small bone window operation group(observation group n=35) and microscope small bone window operation group(control group n=31).According to the analysis of the results,the operation time,intraoperative bleed loss,incidence of postoperative complications,hematoma clearance rate,length of hospital stay and GOS,GCS and ADL scores 90 days after operation were compared between the two groups. Results The operation time,intraoperative blood loss,length of hospital stay and incidence of postoperative complications in observation group were significantly lower than those in control group ( P<0.05).The hematoma clearance rate of observation groupwas better than thatincontrol group ( P<0.05);90 days after operation,the GOS,GCS and ADLscores of observation group were better than those incontrol group ( P<0.05). Conclusion 3D-slicer software can better help locate the hematoma,clarify the blood vessels and nerve conduction bundle around the hematoma,and guide the operation to avoid important blood vessels and nerve conduction bundle.3D-slicer software can help operators find the shortest and optimal surgical path,effectively shorten the operation time,reduce the amount of intraoperative bleeding,reduce the length of hospital stay,reduce the incidence of postoperative complications,Improve the prognosis 90 days after operation,improve the clinical prognosis,and better restore self-care.

Objective To investigate the olfactory disorder and clinical characteristics of spastic torticollis(ST),and to analyze the relationship between ST patients and motor symptoms and non motor symptoms. Methods A total of 32 patients with ST diagnosed in the Institute of Neurology of Anhui University of Traditional Chinese medicine from January 2021 to December 2021 and 32 healthy controls roughly matched with the right-hand,gender,age and educational background of the patient group were collected the odor thresholds,odor discrimination and odor identification of ST group and control group were evaluated with the olfactory stick developed by the Institute of Psychology of the Chinese Academy of Sciences,Toronto Western spasmodic torticollis rating scale(TWSTRS) was used to evaluate the motor symptoms,disability index and pain score of ST group.The Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),Pittsburgh sleep quality index(PSQI) and Montreal Cognitive Assessment(MoCA) were compared between the two groups. Results (1) The total scores of odor thresholds,odor discrimination,odor identification and olfactory function in ST group were lower than those in the control group( P＜0.001),and the scores of HAMA( P=0.007),HAMD( P=0.023) and PSQI( P＜0.001) in ST group were higher than those in the control group( P＞0.05,table 1) there was no difference between the two groups.(2) The total score of odor identification function in ST patients was positively correlated with MOCA( r=0.589, P=0.000),and negatively correlated with age( r=-0.385, P=0.03).There was no correlation between olfactory function and course of disease,TWSTRS motor score,TWSTRS disability score,TWSTRS pain score,HAMA,HAMD and PSQI. Conclusion The incidence of olfactory disorder in ST patients was high,which was manifested by the overall reduction of odor thresholds,odor discrimination and odor identification function.There was no correlation between olfactory disorder and motor symptoms,pain,anxiety,depression and sleep disorder relevance.

Objective To study the effect of atorvastatin (ATO) combined with dexamethasone (DXM) on the recurrence of chronic subdural hematoma after drilling and drainage. Methods By using the method of systematic evaluation,the relevant literatures on Atorvastatin Combined with dexamethasone in the treatment of chronic subdural hematoma in PubMed,Cochrane,EMBASE,CNKI,Wanfang and other databases were retrieved,and the database was established until December 31,2021.The eligible literatures were included in the study.The extracted analysis index was the recurrence rate of hematoma.The quality of the included literatures was evaluated by the Newcastle Ottawa document quality rating scale (NOS).The revman5.3 statistical software was used for meta-analysis. Results A total of 5 articles were included in this study,including 338 patients.The NOS score of the included articles was 6~8.The recurrence rate of hematoma in ATO combined with DXM group (1.2%) was significantly lower than that in control group (single oral ATO) (13.6%),and the difference was statistically significant ( OR=0.12,95%CI:0.04~0.39, P＜0.001, I ²=0%). Conclusion Compared with single oral ATO,oral ATO and DXM can reduce the recurrence rate of hematoma in CSDH patients after drilling and drainage.For CSDH patients with repeated recurrence or high risk of recurrence,oral ATO and DXM can be taken after drilling and drainage.

Objective To investigate the clinical imaging and molecular pathological features of elderly patients with brain tumor. Methods A retrospective analysis of imaging,promoter methylation of O6-methylguanine-DNA-methyltransferase (MGMT) and IDH1R132H in 43 elderly patients with brain tumor with complete follow-up data from May 2016 to May 2020 in the First Affiliated Hospital of University of Science and Technology of China And 1p/19q co-deletion and prognosis of patients. Results Among the 43 elderly patients,32 cases were high-grade glioma and 11 cases were low-grade glioma.The MRI manifestations of high-grade gliomas were as follows:slightly long T1 mixed with T2 signals,with unclear boundaries,obvious uneven enhancement on enhanced scan,accompanied by cystic changes of different sizes,and patchy edema around the lesions.The mean survival time of elderly gliomas was 14.12± 9.09 months,the mean survival time of elderly high-grade gliomas was 9.69± 3.94 months,and the mean survival time of elderly low-grade gliomas was 27.00± 7.31 months.There was a significant difference in survival between high-grade and low-grade elderlygliomas ( P<0.0001).The demethylation degree of MGMT promoter in elderly gliomas was 27.90%,and the positive rate of MGMT methylation promoter in high-grade tumors was only 15.63%.The IDH1R132H mutation rate was only 34.88%,among which,the IDH1R132H mutation rate in high-grade glioma was only 18.75%.Combined deletion of 1p/19q accounted for 20.93%,of which only 12.50% were high-grade gliomas.Moreover,these molecular pathological markers were statistically significant in different grades of geriatric gliomas. Conclusion The Results of this single-center study showedthatelderly gliomas are mainly high-grade gliomas,brain gliomas have obvious imaging specificity,MGMT promoter methylation,IDH1R132H mutation and 1p/19q combined deletion have statistical differences in different grades of elderly gliomas.

Objective To investigate the clinical efficacy and prognostic factors of stereotactic radiotherapy for brain metastasis of colorectal cancer. Methods The general clinical features,clinical efficacy and prognostic factors of 39 patients with brain metastasis from colorectal cancer treated with stereotactic radiotherapy with or without chemotherapy were reviewed retrospectively. Results The primary site were mainly in the rectum and left colon and .There were 36 patients with extracranial metastasis.The cumulative rates of brain metastases were 10.3%(4/39),51.3%(20/39) and 84.6%(33/39) at 1,3 and 5 years.All patients had postoperative rectal cancer,which occurred after lung or livermetastasis.The local control rate of short-term efficacy evaluation was 94% at 6 months and 89% at 12 months,and the median survival was 10.6 months.Adverse reactions,including transient cerebral edema and radiation brain injury,were alleviated with symptomatic treatment and bevacizumab.Multivariate analysis showed that the independent risk factors for prognosis of patients with colorectal cancer BMS were the number of BMS and treatment mode(all P<0.05). Conclusion Brain metastases of colorectal cancer occur mostly after lung and liver metastases with poor prognosis.Stereotactic radiotherapy combined with chemotherapy and targeted therapy(bevacizumab) prolongs patient survival.Survival analysis showed that the number of BMS and treatment pattern were independent risk factors affecting patients with brain metastasis of colorectal cancer.