Objective To explore the clinicopathological features and molecular genetics of diffuse leptomeningeal glioneuronal tumor (DLGNT). Methods and Results A 5 - year- old boy presented with severe hydrocephalus and two times of convulsions. Head MRI showed obvious broadening of bilateral lateral ventricles, suggesting hydrocephalus, and abnormal patchy mildly high-intensity signals scattered in bilateral cerebellar superior sulci; spinal MRI revealed thickened spinal cord at the level of T5-7 and mildly high-intensity signals within the spinal cord; enhanced MRI showed thickening and enhancement of the surface of brainstem, meninges on the surface of bilateral cerebellar hemispheres, whole spinal meninges and partial spinal dura mater, and cauda equina. The patient underwent exploratory resection of thoracic lesions and spinal canal reconstruction. Intraoperative findings showed semi - transparent gelatinoid hyperplasia between subarachnoid and soft meningeal, which blocked the subarachnoid cavity. Histological findings showed low-to moderate-density monomorphic oligdendroglial-like tumor cells with diffusely growth or in small nests in the leptomeninges. Mitotic activity and necrosis were not found. Immunohistochemical staining showed oligdendroglial-like tumor cells expressed oligodendrocytes transcription factor-2 (Olig-2) in nuclei, synaptophysin (Syn), microtubule - associated protein - 2 (MAP - 2) and S - 100 protein (S -100) in cytoplasm. Ki-67 labeling index was 4%-10%. Fluorescence in situ hybridization (FISH) analysis revealed deletion of 1p, whereas 19q was intact. The final diagnosis was DLGNT. The patient was hospitalized for 22 d and died 3 months after discharge. Conclusions DLGNT is a group of primary brain neoplasm of recent acquisition in the 2016 World Health Organization (WHO) classification of central nervous system tumors and does not yet assign a distinct WHO grade to the entity. At present, DLGNT has not been reported in China. DLGNT is very rare and always confused with other central nervous system tumors and inflammatory lesions. Therefore, histological morphology, immunohistochemistry and characteristics of molecular genetics are very important for diagnosis. DOI: 10.3969/j.issn.1672-6731.2018.07.010

The cingulate gyrus is crescent?shaped convolution on the medial surface of cerebral hemisphere between cingulate sulcus and corpus callosum. Cingulate gyrus is an integral component of the limbic system and Papez's circuit, including anterior cingulate cortex (ACC) middle cingulate cortex (MCC) and posterior cingulate cortex (PCC). ACC have numerous functions: emotion, cognition, motor, visceromotor, maternal behavior and social activities. PCC is considered to be involved in visuospatial and memory function. ACC epilepsy is a peculiar epileptic syndrome with a broad range of clinical manifestations including blunting, hypermotor and postural tonic seizures, as well as autonomic symptoms and mood alteration. The manifestations of MCC epilepsy are tonic or clonic seizures on contralateral or bilateral extremities. PCC is semiologically on the silent area. Furthermore, the spread of seizure activity from this area to limbic network or other symptomatogenic areas can contribute to miscellaneous symptoms. DOI: 10.3969/j.issn.1672-6731.2018.05.004

Objective To compare the difference of the rate of cholesterol crystals in thrombi obtained from patients of acute ischemic stroke with different etiologies and the effect of thrombi containing cholesterol crystals on vascular recanalization. Methods A total of 92 patients with acute ischemic stroke caused by intracranial large vascular occlusion underwent endovascular treatment, such as catheter suction, thrombectomy, balloon dilatation and stent implantation. Histopathological examinations of the retrieved thrombi were performed. Results Of 92 cases, 81 cases (88.04%) achieved recanalization [Thrombolysis in Cerebral Infarction (TICI) ≥ 2b]. Thrombi were retrieved in 66 cases (71.74%) and 63 cases (68.48%)performed pathological examinations, among whom 26 cases (41.27%) were atherothrombosis (AT), 24 cases (38.10%) were cardioembolism (CE), 2 (3.17%) were stroke of other determined etiology (SOD) and 11 cases (17.46%) were stroke of undetermined etiology (SUD). Among 26 AT cases, 18 cases (69.23%) accepted endovascular treatment and 8 cases (30.77% ) accepted bridging therapy. One case (3.85% ) underwent catheter suction, and 25 cases (96.15%) underwent thrombectomy, including thrombectomy alone in 9 cases (34.62% ), thrombectomy combined with balloon dilatation in 3 cases (11.54% ), thrombectomy combined with stent implantation in 3 cases (11.54% ), thrombectomy combined with balloon dilatation and stent implantation in 10 cases (38.46%), respectively. Cholesterol crystals were detected in 4 cases (15.38%). There was no significant difference in the number of thrombectomy between thrombi with cholesterol crystals and those without cholesterol crystals [2.50 (2.00, 3.00) times vs. 2 (2, 2) times; Z = ? 1.155, P = 0.248]. Among 37 non ? AT cases, 26 cases (70.27% ) accepted endovascular treatment and 11 cases (29.73%) accepted bridging therapy. All of them underwent thrombectomy, including thrombectomy alone in 34 cases (91.89%), thrombectomy combined with balloon dilatation in one case (2.70%), thrombectomy combined with stent implantation in 2 cases (5.41% ), respectively. There was statistically significant difference in the rate of cholesterol crystals between AT cases and non?AT cases [15.38% (4/26) vs. 0/37， Fisher's exact probability: P = 0.025]. There was no significant difference in the rate of cholesterol crystals between patients with and without recanalization [3.77% (2/53) vs. 2/10, Fisher's exact probability: P = 0.115]. Conclusions Although the rate of cholesterol crystals in thrombi of acute ischemic stroke patients is relatively low, it is specific for diagnosing AT. Besides, cholesterol crystals has no relationship with vascular recanalization. DOI: 10.3969/j.issn.1672-6731.2018.05.011

Objective To investigate the incidence of restless legs syndrome (RLS) in hemodialysis patients and to analyze the related risk factors. Methods There were 220 cases of hemodialysis as hemodialysis group and 40 cases of chronic nephrosis as control group. The severity of RLS was measured by International Restless Legs Syndrome Study Group Rating Scale (IRLS). Beck Depression Inventory (BDI) was used to evaluate the status of depression, Epworth Sleepiness Scale (ESS) was used to evaluate excessive daytime sleepiness (EDS), and Insomnia Severity Index (ISI) was used to evaluate the status of insomnia. Univariate and multivariate forward Logistic regression analysis was used to analyze the related risk factors for RLS in hemodialysis patients. Results In hemodialysis group duration ( Z =-9.837, P = 0.000), serum ferritin ( t = 2.847, P = 0.005), incidence rate of RLS ( χ 2 = 10.918, P = 0.001), the proportion of using hypnotic drugs ( χ 2 = 7.669, P = 0.006), IRLS ( t = 2.322, P = 0.020) and ISI ( Z = 4.117, P = 0.001) were significantly higher than control group. Univariate and multivariate forward Logistic regression analysis showed diabetes ( OR = 3.387, 95% CI: 1.538-7.461; P = 0.002), BDI > 9 score ( OR = 2.643, 95% CI: 1.457-4.795; P = 0.001) and ISI > 7 score ( OR = 3.542, 95%CI: 1.939-6.468; P = 0.000) were independent risk factors for RLS in hemodialysis patients. Conclusions Hemodialysis patients have a high incidence of RLS and insomnia. RLS is closely related with insomnia. Depression plays an important role therein. DOI: 10.3969/j.issn.1672-6731.2018.01.009

Objective To observe and explore the activation pattern and functional reorganization mechanism of motor cortex in acute ischemic stroke patients. Methods A total of 22 patients with first-ever acute ischemic stroke were included in this study. Functional magnetic resonance imaging (fMRI) was used to observe the changing of activation pattern and functional reorganization of motor cortex in finger-tapping task. National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) were used to evaluate motor function, and neuroelectrophysiology monitored resting motor threshold (RMT). Spearman rank correlation analysis was used to analyze the correlation between activation of region of interest (ROI) and neurological function, motor function and neuroelectrophysiology. Moreover, dynamic causal model (DCM) was used to analyze the intrahemispheric and interhemispheric effective connectivity between brain regions in finger-tapping task. Results Movements of the affected hand showed significant signal activation in the ipsilesional primary motor cortex (M1), premotor cortex (PMC) and bilateral supplementary motor area (SMA), while the contralesional PMC, posterior parietal cortex (PPC) and bilateral cerebellar hemisphere also showed slight activation. Movements of the unaffected hand showed significant activation in the contralesional M1, PMC and SMA, while the ipsilesional SMA and inferior parietal lobule also showed slight activation. The activation value of ipsilesional M1 was negatively correlated with neurological function (NIHSS score; r s = -0.452, P = 0.035) and positively correlated with motor function of upper extremity (FMA-UE score; r s = 0.543, P = 0.009). The activation value of ipsilesional sensorimotor cortex (SMC) was positively correlated with RMT ( r s = 0.718, P = 0.001). The advantage model of DCM showed bidirectional suppressive influence of connectivity between bilateral M1, negative effective connectivity from contralesional SMA to M1, positive effective connectivity from contralesional SMA to ipsilesional M1 and from ipsilesional SMA to contralesional SMA. The intensity of effective connectivity from contralesional to ipsilesional M1 was negatively correlated with motor function (FMA-UE score; r s = -0.461, P = 0.047). The intensity of effective connectivity from contralesional SMA to contralesional M1 was positively correlated with motor function (FMA-UE score; r s = 0.533, P = 0.041). Conclusions fMRI combined with neurological function, motor function and electrophysiology can be used to observe activation pattern and functional reorganization mechanism of motor cortex in acute ischemic stroke patients, and provide new insights into understanding the motor impairment and functional reorganization after stroke and rehabilitation therapy. DOI: 10.3969/j.issn.1672-6731.2017.12.005

Objective To estimate the effect of lorazepam in relieving postoperative wound pain and anxiety after spinal meningioma surgery. Methods A total of 106 patients underwent spinal meningioma resection with endotracheal general anesthesia. They were randomly divided into lorazepam group (N = 53) and control group (N = 53). Patients in lorazepam group were given lorazepam 0.50 mg one night before surgery and 6 h after surgery, while control group were given compound vitamin B at the same time. Operation time, intraoperative bleeding and wound healing after surgery were recorded. McCormick grade and Self-Rating Anxiety Scale (SAS) were used to evaluate the spinal function and anxiety. At 48 h after surgery, Visual Analogue Scale (VAS) was used to evaluate the degree of postoperative pain. Results All patients underwent tumor total resection, and spent the perioperative period safely. No complications such as infection happened. Neurological function were relieved to varying degrees and there was no worsening case. Compared with control group, SAS score in lorazepam group was significantly decreased at 48 h after surgery ( P = 0.000). Compared with before surgery, SAS score in lorazepam group was significantly decreased at 48 h after surgery ( P = 0.000). The VAS score at 48 h after surgery in lorazepam group was significantly lower than control group [(5.40 ± 1.24) score vs. (7.15 ± 1.12) score; t = 7.593, P = 0.000]. Conclusions Lorazepam as an antianxiety agent can effectively relieve postoperative pain after spinal meningioma resection. DOI: 10.3969/j.issn.1672-6731.2017.12.011

Cerebral hyperperfusion syndrome (CHS) is a rare syndrome deriving from carotid endovascular treatment with a high mortality. CHS can be derived by carotid endarterectomy (CEA), carotid artery stenting (CAS) and intracranial artery stenting. This review aims to summarize the progress of clinical manifestations, risk factors, pathogenesis, diagnostic criteria, prevention and treatment for CHS in recent years. DOI: 10.3969/j.issn.1672-6731.2017.12.003

Objective To compare the three-dimensional anatomic differences of far lateral approach versus presigmoidal approach to expose inferior clivus by virtual reality technique. Methods CT and MRI image data of 15 cadaver heads (30 sides) were inputted into Vitrea virtual reality system to establish three-dimensional anatomy model of posterior cranial fossa. Three points including anterior edges of bilateral tubercula jugulare and tubercula pharyngeum were selected to form a plane. The region of inferior clivus was defined as area under the aforementioned plane. The anterior edge of intersection curve between the plane and the clivus was selected as skull base landmark to expose. The mastoidale and posterior edge of occipital condyle articular surface were selected as craniotomy landmarks of presigmoidal and far lateral approaches. Cylinder with 1 cm diameter was outlined to simulate surgical approach, of which the axis passed through the aforementioned craniotomy landmarks. The superior edge of bottom surface of cylinder on the side of skull base was located in the aforementioned landmark of skull base. Anatomic exposures of the above two approaches were compared by paired t test. Results The far lateral approach located at the lateral edge of foramen magnum, anterior to the cerebellum, lateral to the brain stem, medial to the jugular bulb, lateral and inferior to the accessory nerve, involved hypoglossal nerve and reached inferior clivus. Bone drilling through presigmoidal approach began with mastoidale. The approach passed through inferior edge of jugular bulb, anterior to the sigmoid sinus, inferior to the accessory nerve, involved hypoglossal nerve at the lateral edge of foramen magnum, reached inferior clivus anterior to the brain stem. The volumes of surgical route [(4629.80 ± 81.00) mm3 vs. (2622.60 ± 72.58) mm3; t = 91.532, P = 0.000] and route involving hypoglossal nerve [(10.15 ± 0.17) mm3 vs. (7.15 ± 0.20) mm3; t = 52.413, P = 0.000] through presigmoidal approach were more than those through far lateral approach. Osseous structures involved in far lateral approach was more than that in presigmoidal approach [(2362.90 ± 80.18) mm3 vs. (1851.60 ± 63.62) mm3; t = 25.714, P = 0.000]. Conclusions Passing through hypoglossal nerve and drilling partial osseous structures will help to avoid cerebellum and brain stem and expose inferior clivus through far lateral approach and presigmoidal approach. DOI: 10.3969/j.issn.1672-6731.2017.12.008