Objective To explore the clinicopathological features of extraventricular neurocytoma located in the sellar/suprasellar region. Methods The clinical manifestations, neuroimaging, histopathological, immunohistochemical and molecular genetic features were retrospectively analyzed in one case of sellar/suprasellar extraventricular neurocytoma, and the related literatures were reviewed. Results A 27-year-old female presented with intermittent headache, accompanied by blurred vision for 5 months. Head MRI demonstrated a mass with a well-defined margin measuring 3.80 cm × 2.50 cm × 3.40 cm located in the sellar/suprasellar region. The tumor showed isointense to hyperintense signals on T 1 WI and hyper-hypointense mixed signals on T 2 WI, and slightly hyperintense signal on diffusion-weighted imaging (DWI). The pituitary was not shown. A transsphenoidal sellar tumor resection, cerebrospinal fluid (CSF) rhinorrhea repairing and optic decompression were performed. The mass was lightly yellow and tough with abundant blood supply and filled with old hemorrhage. The pituitary tissue was pushed to the left rear. Microscopy examination showed a diffuse invasive growth pattern with neuropil background in some area. The tumor cells were uniform on size and shape with round to oval, exquisite and hyperchromatic nuclei. No mitosis was found. Immunohistochemical staining showed the tumor cells were positive for neuronal nuclei (NeuN) and thyroid transcription factor-1 (TTF-1) in nuclei, calretinin (CR) in nuclei and cytoplasm, synaptophysin (Syn), chromogranin A (CgA), E-cadherin, matrix metalloproteinase-9 (MMP-9) in cytoplasm, and focally positive for S-100 protein (S-100) in nuclei, and neurofilament protein (NF), cytokeratin 8 (CK8) and vimentin (Vim) in cytoplasm. The Ki-67 labeling index was about 3%. The tumor tissue was negative for reticular fiber staining. Molecular genetic analysis showed that isocitrate dehydrogenasel (IDH) gene was not mutated, and 1p/19q was intact in tumor cells. The final pathological diagnosis was extraventricular neurocytoma, WHO grade Ⅱ. Conclusions Extraventricular neurocytoma located in the sellar/suprasellar region is very rare. The histological features are similar to central neurocytoma in ventricle. Tumor cells were in diffusely invasive growth and were uniform in size and shape, with round nuclei. Fibrillary areas mimicking neurophil and branching thin-walled capillaries can be seen. The differential diagnosis includes pituitary adenoma, oligodendroglioma, clear cell ependymoma, and so on. DOI: 10.3969/j.issn.1672-6731.2017.12.009

Alzheimer's disease (AD) is a neurodegenerative disease of unknown etiology and pathogenesis. The typical pathological changes of AD include neuritic plaques [NPs, senile plaques (SPs)] with deposition of β-amyloid protein (Aβ) and neurofibrillary tangles (NFTs) due to abnormal aggregation of tau protein. Researches show that cholinergic system is related to AD, and butyrylcholinesterase (BChE) plays an important role in AD. This article reviews the important role of BChE in the pathogenesis of AD. DOI: 10.3969/j.issn.1672-6731.2017.12.013

Objective To investigate the occurrence rate and related risk factors for post-stroke emotional incontinence (PSEI). Methods The clinical data [sex, age, body mass index (BMI), education, marital status, medical history (hypertension, heart disease, diabetes, hyperlipemia, smoking and drinking) and family history of stroke] of 162 stroke patients were recorded. Serum homocysteine (Hcy) level was examined. Head CT and/or MRI were used to indicate stroke subtype, site of lesion and number of lesion. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-Ⅴ) Chinese version and Hamilton Depression Rating Scale-17 Items (HAMD-17) were used to evaluate the degree of depression. House diagnostic standard was used to diagnose PSEI. Univariate and multivariate backward Logistic regression analysis was used to screen related risk factor for PSEI. Spearman rank correlation analysis was used to discuss the correlation between PSEI and post-stroke depression (PSD). Results Among 162 stroke patients, 12 cases were diagnosed as PSEI (7.41% ). The ratio of age < 60 years in PSEI group was significantly higher than non-PSEI group ( P = 0.045). The ratio of smoking in PSEI group was significantly lower than non-PSEI group ( P = 0.036). Univariate and multivariate backward Logistic regression analysis showed age < 60 years was independent risk factor for PSEI ( OR = 4.000, 95%CI: 1.149-13.924; P = 0.029). Ten cases were combined with PSD in 12 PSEI patients, and the co-morbidity rate of PSEI and PSD was83.33%. Spearman rank correlation analysis showed PSEI was positively related to PSD ( r s = 0.305, P = 0.000). Conclusions PSEI is common affective disorder in stroke patients, which easily happens in patients under 60 years of age. DOI: 10.3969/j.issn.1672-6731.2017.12.010

Objective To investigate the clinical and imaging manifestations of cerebral venous sinus thrombosis (CVST), and the clinical effect of combined treatment of anticoagulation and endovascular thrombolysis. Methods and Results The clinical manifestations of 22 CVST patients were highly variable. Headache (90.91%, 20/22) was the most frequent symptom, and conscious disturbance, seizure and focal neurological deficits were commonly present. Plasma D-dimer level was elevated in 12 patients (54.55%). Lumbar puncture was performed in 14 patients, in whom intracranial hypertension was present in 9 patients (9/14) with no characteristic changes in routine and biochemical examination of cerebrospinal fluid (CSF). Brain CT/MRI and CTV/MRV showed direct signs of CVST in all 22 patients, involving superior sagittal sinus, transverse sinus, sigmoid sinus, straight sinus and cortex veins, parenchymal lesions (infarction, hemorrhage and white matter abnormalities) in 13 patients (59.09%), subarachnoid hemorrhage (SAH) in 2 patients (9.10%) and subdural hematoma in one patient (4.55%). The involved cerebral sinuses revealed by DSA were superior sagittal sinus in 13 patients (59.09% ), transverse sinus in 17 patients (77.27%), sigmoid sinus in 14 patients (63.64%), inferior sagittal sinus in 2 patients (9.10%), straight sinus in 4 patients (18.18%), vein of Galen in one patient (4.55%) and jugular vein in one patient (4.55%). Two thrombosed sinuses were found in 9 patients (40.91% ) and 3 or more thrombosed sinuses in 8 patients (36.36% ). As no clinical improvements and progressive exacerbation were observed several days after heparin sodium intravenous drip or lower molecular weight heparin (LMWH) hypodermic injection with oral warfarin anticoagulant therapy, urokinase thrombolysis in venous sinus or artery was applied in 21 patients (95.45%). After (25.70 ± 12.18) d treatment with anticoagulation, the modified Rankin Scale (mRS) score of 13 patients (59.09% ) reached 0-1, 4 patients (18.18% ) 2 and 5 patients (22.73% ) 3-4, with the total effective rate reaching 77.27% (17/22). Conclusions The severely affected CVST usually have multiple sinus thromboses, deep venous thrombosis and parenchymal lesions. Endovascular thrombolysis together with primary anticoagulation may result in good outcomes in these patients. DOI: 10.3969/j.issn.1672-6731.2017.12.006

Moyamoya disease (MMD) is a chronic progressive obstructive cerebrovascular disease. At present, the etiology and pathogenesis of MMD are still not clear. Recently, many studies confirmed the genetic susceptibility of MMD and reported that the genetic factors are more important than acquired causes. We summarize the domestic and foreign studies on the genetics of MMD, and expect to provide a guidance for early diagnosis and precise treatment. DOI: 10.3969/j.issn.1672-6731.2017.12.012

Chinese classification of cerebrovascular diseases (2015), published in 2017, attracts much attention. Cerebrovascular diseases are separated into 13 categories according to their etiology, pathogenesis, lesion arteries, lesion sites, clinical manifestations and complications. Some new contents or differences are discussed and compared with the earlier version, which is expected to acquire deeper comprehension and make better choices of clinical work. DOI: 10.3969/j.issn.1672-6731.2017.12.002

Objective To systematically review the risk factors for in-stent restenosis (ISR) of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment. Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS) and Stata 12.0 software. Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440) and non-ISR group (N = 912). The ISR incidence rate of smokers was significantly higher than non-smokers ( OR = 2.179, 95%CI: 1.373-3.458; P = 0.001). The differences of bare metal stents (BMS) utilization rate ( OR = 2.072, 95% CI: 1.560-2.753; P = 0.000) and drug-eluting stents (DES) utilization rate ( OR = 0.483, 95% CI: 0.363-0.641; P = 0.000) between ISR group and non-ISR group were statistically significant. Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004

Objective To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome. Methods A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded. Results Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis ( OR = 0.316, 95% CI: 0.102-0.982; P = 0.046). Conclusions Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better. DOI: 10.3969/j.issn.1672-6731.2017.11.004

With the development of new technology and new materials, endovascular therapy has become the main treatment of intracranial aneurysms. The 70-year development of intracranial aneurysms endovascular therapy mainly includes 3 stages: firstly, the electric coagulation induced thrombosis of intracranial aneurysms in the period of 1940-1960; secondly, balloon embolization of intracranial aneurysms during 1970-1990; thirdly, coil embolization of intracranial aneurysms during the period from 1990 to the present. In recent years, the widespread use of flow diverter devices and intrasaccular flow disruptor have opened up a new direction for the treatment of intracranial aneurysms. DOI: 10.3969/j.issn.1672-6731.2017.11.002