Parkinson's disease (PD) is a common neurodegenerative disease in the elderly, of which cognitive impairment is the most common non-motor symptom (NMS) affecting the life quality of patients. Cognitive impairment is associated with many factors, and white matter hyperintensity (WMH) is an important pathological change of cognitive impairment in PD. In this paper, we will explain the relationship between WMH and cognitive impairment in PD by the perspective of neuronal pathway, white matter volume change and diffusion tensor imaging (DTI), to provide a new direction for the early diagnosis of PD. DOI: 10.3969/j.issn.1672-6731.2017.11.012

Objective To summarize clinical and pathological features, diagnosis and differential diagnosis, as well as treatment and prognosis through analyzing one case of collision tumor in the sellar region (pituitary adenoma combined with malignant triton tumor). Methods and Results A 59-year-old male was admitted to hospital with decreased vision, vision field defect and dizziness. Head MRI demonstrated space-occupying lesion in the sellar region. Therefore, the patient underwent a transsphenoidal surgery with subtotal tumor resection. Three months later, the patient was admitted to hospital again with vision loss and headache. Head CT demonstrated space-occupying lesions in sellar/suprasellar region, therefore, the patient underwent saddle tumor resection. Histological findings revealed that the tumor was composed of two different types of tumors, one was pituitary adenoma with epithelial cells arranged in nest-like and trabecular pattern, and the other was diffused spindle cell tumor. The two tumors were distributed separately or mixed togenther. The morphology of spindle cell tumor was bland with scarce mitosis in the first surgery, whereas additional features including increased cell density, dark nuclei, frequent mitosis and scattering distributed rhabdomyoblasts were found in the second surgery. Immunohistochemically, the pituitary adenoma (epithelial cell region) cells were positive for cytokeratin 8 (CK8), chromogranin A (CgA), synaptophysin (Syn) and thyroid stimulating hormone (TSH), while the malignant triton tumor cells (spindle cell region) were positive for CD56, CD57, calretinin (CR) and focally positive for S-100 protein (S-100), desmin (Des) and myogenin. Ultrastructural findings revealed abundant rough endoplasmic reticules and secretary granules in the cytoplasm of pituitary adenoma cells, and discontinuous basal lamina located outside the spindle cell membrane. The final pathological diagnosis was sellar collision tumor (non-functional TSH adenoma combined with malignant triton tumor). The patient died 6 months after the second surgery. Conclusions Collision tumor of the sellar region with pituitary adenoma and malignant triton tumor is a rare tumor which can hardly be diagnosed by clinical and neuroimaging examination. The diagnosis relies on morphological characteristics, immunophenotype and ultrastructural features. The prognosis of collision tumor with malignant triton tumor component is poor. DOI: 10.3969/j.issn.1672-6731.2017.11.009

Objective To evaluate the efficiency and safety of endovascular thrombectomy for acute ischemic stroke caused by acute large vessel occulsion. Methods A total of 41 patients with acute ischemic stroke caused by acute large vessel occulsion were treated with endovascular thrombectomy. Time from onset to admission, from admission to femoral artery puncture, from onset to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function at 24 h after operation. Modified Rankin Scale (mRS) was used to evaluate clinical prognosis at 90 d after operation. Perioperative procedure-related complications and occurrence rate of symptomatic intracranial hemorrhage within at 90 d after operation were recorded. American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) Collateral Flow Grading System (ACG) was used to assess collateral compensation of anterior circulation. BATMAN score was used to assess collateral compensation of posterior circulation. Results Among 41 patients, 12 (29.27%) were treated with recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis. There were 32 patients (78.05%) achieved successful recanalization, including 20 patients (80%, 20/25) in anterior circulation and 12 (12/16) in posterior circulation, and no significant difference was seen between them (adjusted χ 2 = 1.424, P = 0.706). At 24 h after operation, 28 patients (68.29%) had better neurological function than preoperation (NIHSS decreasing ≥ 4 score), including 18 patients (72%, 18/25) with anterior circulation occlusion and 10 (10/16) with posterior circulation occlusion, and there was no significant difference between them (χ 2 = 0.407, P = 0.524). Eleven patients (26.83%) died within 90 d after operation, including 4 patients (16%, 4/25) with anterior circulation occlusion and 7 (7/16) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 2.130, P = 0.144). Among the 11 dead, 3 died of complicated pulmonary infection and respiratory failure, and 8 died of ischemic stroke. The other 30 patients were followed up for 3 months to one year, average (231.92 ± 95.36) d. At 90 d after operation, 14 patients (34.15%) had good outcome (mRS ≤ 2 score), including 10 patients (47.62%, 10/21) with anterior circulation occlusion and 4 (4/9) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 0.493, P = 0.483). Among 41 patients, 6 patients (14.63% ) had symptomatic intracranial hemorrhage, including 4 patients (16% , 4/25) with anterior circulation occlusion and 2 (2/16) with posterior circulation occlusion, and no significant difference was seen between them (adjusted χ 2 = 3.303, P = 0.856). Collateral compensation was evaluated in 33 patients (20 with anterior circulation occlusion and 13 with posterior patients circulation occlusion). In 20 patients with anterior circulation occlusion, 14 patients (70%) had good collateral compensation, in whom 9 (9/14) had good outcome 90 d after operation, while the other 6 patients (30%) had poor collateral compensation and then had good outcome 90 d after operation, and significant difference was seen between them (Fisher exact probability: P = 0.014). Among 13 patients with posterior circulation occlusion, 3 patients (3/13) had good collateral compensation and had good outcome 90 d after operation, while the other 10 (10/13) had poor collateral compensation, in whom one (1/10) had good outcome 90 d after operation, and significant difference was seen between them (Fisher exact probability: P = 0.014). Conclusions Endovascular thrombectomy is an efficient and safe method for acute ischemic stroke caused by acute large vessel occlusion. Rigorously master the indication and preoperative evaluation, and perfect acute rescue procedure and treatment for stroke may increase the efficacy of endovascular thrombectomy. DOI: 10.3969/j.issn.1672-6731.2017.11.005

Objective To investigate the incidence, occurrence time and electrophysiological characteristics of rapid eye movement behavior disorder (RBD) in patients with early Parkinson's disease (PD), and the characteristics of motor symptoms and non . motor symtoms (NMS). Methods Sixty PD patients were divided into PD + RBD group (N = 42) and control group (N = 18) according to whether they were complicated with RBD or not. Unified Parkinson's Disease Rating Scale (UPDRS)Ⅱ andⅢ, Hoehn-Yahr Stage, Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), RBD Screening Questionnaire (RBDSQ), Epworth Sleepiness Scale (ESS) and polysomnography (PSG) were used in 60 patients. Results Among 60 patients, 42 (70% ) were accompanied by RBD. PSG showed that PD + RBD patients mainly presented upper limb stretching and gripping, body twitching, laughing, shouting, cursing and other non.violent actions, except 2 cases presented violent actions, such as hitting, kicking, etc. In PD + RBD group, the age was older (P = 0.024), duration was longer (P = 0.000), and UPDRSⅡ (P = 0.005)，UPDRSⅢ(P = 0.001), the scale values of Hoehn-Yahr Sotage 2 (P = 0.007), anxiety (P = 0.044) and depression (P = 0.001) ratio were all higher than control group. There were significant differences in density of mandible myoelectric activity (P = 0.000) and ratio of rapid eye movement (REM) without atonia (P = 0.000) between 2 groups. In PD + RBD group, 16 patients (38.10% ) had symptoms of RBD, earlier than PD occurred 5.20 (3.91, 6.51) years. Conclusions PD patients with older age, longer duration, more severe motor symptoms and non?motor symptoms were more likely to be accompanied by RBD. The severity of RBD in PD patients accompanied with RBD is higher than that in PD without RBD. RBD may be the early manifestation of PD. PSG has important value in the diagnosis of PD with RBD. DOI: 10.3969/j.issn.1672-6731.2017.10.006

Ischemic stroke has a high disability rate, mortality and recurrence rate. The term of recurrent ischemic stroke is patient's conditions occur again after improvement or recovery of ischemic stroke. The disability rate and mortality of recurrent ischemic stroke will be significantly higher than those after the first onset. In this paper, the related risk factors for recurrent ischemic stroke were reviewed to provide the basis of secondary prevention for ischemic stroke, and to reduce the incidence of recurrent ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2017.10.011

Research shows that autoimmune encephalitis is associated with sleep disorders. Paraneoplastic neurological syndrome (PNS) with Ma2 antibodies can cause sleep disorders, particularly narcolepsy and rapid eye movement sleep behavior disorder (RBD). Limbic encephalitis (LE) and Morvan syndrome, associated with voltage - gated potassium channel (VGKC)-complex antibodies, which include leucine-rich glioma-inactivated 1 (LGI1) antibody and contactin-associated protein 2 (Caspr2), can result in profound insomnia and other sleep disorders. Central neurogenic hypoventilation are found in patients with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, whereas obstructive sleep apnea (OSA), stridor and parasomnia are prominent features of encephalopathy associated with IgLON5 antibodies. Sleep disorders are cardinal manifestations in patients with autoimmune encephalitis. Immunotherapy possiblely can improve clinical symptoms and prognosis in a positive way. DOI: 10.3969/j.issn.1672-6731.2017.10.004

Spinal department of neurosurgery develops in an all-round way in many European and American countries. The amount spinal surgery can reach half of all the department of neurosurgery surgery. It can be seen that spinal department of neurosurgery has huge development potential. Because of historical reasons, department of neurosurgery in China is less involved in the treatment of spinal and spinal cord diseases, and the diagnosis and treatment techniques in related fields are relatively backward. It is urgent to develop the spinal department of neurosurgery in China, whereas the bottleneck is talent training and reserve. This training program of spinal department of neurosurgery talent development intends to solve this problem. DOI: 10.3969/j.issn.1672-6731.2017.10.010

Objective To evaluate the efficacy of continuous positive airway pressure (CPAP) ventilation treatment for epilepsy with obstructive sleep apnea syndrome (OSAS). Methods The data were collected from the following words: sleep apnoea, obstructive sleep apnoea, OSA, obstructive sleep apnoea syndrome, OSAS, sleep apnoea syndromes, sleep-related breathing disorder, epilepsy, continuous positive airway pressure, CPAP. PubMed, EMBASE/SCOPUS and Cochrane Library retrieval on randomized controlled clinical trials, clinical guidelines, systematic review (including Meta-analysis), case controlled studies and retrospective cohort studies of CPAP ventilation treatment of epilepsy with OSAS from January 1, 1980 to February 28, 2017. Jadad Scale, Cochrane System Evaluation Handbook and RevMan 5.3 software were used for quality assessment and Meta-analysis. Results A total of 1197 English literatures were obtained, and 17 English articles were included in the study, including one clinical guideline, one systematic review, one Meta-analysis, one randomized controlled clinical trial, 10 case controlled studies and 3 retrospective cohort studies. The results showed that: 1) CPAP ventilation treatment can decrease the seizure frequency or even emarge seizure free in epilepsy with OSAS. 2) CPAP ventilation treatment can reduce the seizure frequency of refractory epilepsy with OSAS. 3) CPAP ventilation treatment can reduce the seizure frequency of elderly epilepsy patients with OSAS. 4) Meta-analysis on three clinical studies (153 epilepsy and OSAS patients) with Jadad ≥ 4 scores showed cases with reduction seizure frequency > 50% in CPAP group were more than those in unused CPAP group (RR = 3.170, 95%CI: 1.650-6.090; P = 0.001). Conclusions CPAP ventilation treatment can reduce the seizure frequency of patients with epilepsy and OSAS. The effect of treatment depends on patients compliance. Sudden drug-withdrawl or pressure insuffiency may increase seizure frequency. This conclusion remains to be confirmed. DOI: 10.3969/j.issn.1672-6731.2017.10.005