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About 1/3 of patients with major depression cannot benefit from regular antidepressant therapy, psychotherapy and cognitive behavioral treatment (CBT). Currently, deep brain stimulation (DBS), as a new treatment, has been used to treat major depression. However, only a few medical centers have performed DBS in major depression, and the number of cases is limited. DBS for treating major depression is still in clinical trial stage due to unclear mechanism, lacking of effective stimulation targets, no uniform stimulation parameters, and controversial efficacy. This article reviews mechanism, indications, stimulation parameters, curative effect, complications and future trends of DBS in the treatment of major depression. DOI: 10.3969/j.issn.1672-6731.2018.12.002

Deep brain stimulation is a therapy for Alzheimer's disease (AD) that has previously been used for mainly mild to moderate cases. This study provides the first evidence of early alterations in performance induced by stimulation targeted at the fornix in severe AD patients. The performance of the five cases enrolled in this study was scored with specialized assessments including the Mini-Mental State Examination and Clinical Dementia Rating, both before and at an early stage after deep brain stimulation. The burden of caregivers was also evaluated using the Zarit Caregiver Burden Interview. As a whole, the cognitive performance of patients remained stable or improved to varying degrees, and caregiver burden was decreased. Individually, an improved mental state or social performance was observed in three patients, and one of these three patients showed remarkable improvement in long-term memory. The conditions of another patient deteriorated because of inappropriate antipsychotic medications that were administered by his caregivers. Taken together, deep brain stimulation was capable of improving some cognitive aspects in patients with severe AD, and of ameliorating their emotional and social performance, at least at an early stage. However, long-term effects induced by deep brain stimulation in patients with severe AD need to be further validated. More research should focus on clarifying the mechanism of deep brain stimulation. This study was registered with ClinicalTrials.gov (NCT03115814) on April 14, 2017.

Objective To investigate the efficacy and safety of CyberKnife for giant cavernous hemangioma in cavernous sinus. Methods The data of 7 cases of giant cavernous hemangioma in cavernous sinus region confirmed by imaging examination and treated with CyberKnife were collected. The tumor volume was 11.86-70.12 cm3 (median 23.30 cm3). CT and MRI were acquired and fused by MIM 6.5.4 software. The acquired data sets were imported into a CyberKnife Robotic Radiosurgery System (Multiplan 4.0.2) and used to delineate the target organs at risk. The irradiation doses received by the lesions were 21 Gy/3 times in 5 cases, 25 Gy/5 times in one case and 30 Gy/3 times in one case. The exposure field was 109-155, and target volume reached over 95%. Patients maintained at supine positionduring treatment and utilized a 6D-skull trace mode specific to CyberKnife. Changes of clinical symptoms and imaging immediately after treatment and during follow-up period were observed to evaluate the efficacy and safety of this therapeutic method. Results Patients were followed-up for 6-18 months, and the meanfollow-up period was 9.37 months. Volumes of lesions were calculated after operation. All of these patients showed decrease in tumor volume (35.48% to 84.03% ) and improvement in symptoms (including visual impairment, visual field defect and headaches) after therapy. Postoperative MRI revealed the tumor volume was 6.75-28.35 cm3 (median 10.50 cm3), which were significantly lower than that of before treatment [11.86-70.12 cm3 (median 23.30 cm3); Z = -2.366, P = 0.018]. Only one case presented radioactive cerebral edema, and the symptom was disappeared after 5-day treatment with mannitol and dexamethasone. Conclusions CyberKnife is an effective treatment method for giant cavernous hemangioma in cavernous sinus region. It is suggested to be the first selection for patients with giant cavernous hemangioma in cavernous sinus, who are not suitable for traditional surgeries and general radiotherapy. DOI: 10.3969/j.issn.1672-6731.2015.10.008

Objective To study the efficacy and possible mechanism of deep brain stimulation (DBS) in bilateral anterior thalamic nuclei (ATN) for drug-resistant epilepsy. Methods Three cases with drug-resistant epilepsy underwent DBS in bilateral ATN. Preoperative and postoperative assessment included the frequency of seizures, seizure types, kinds and dosage of anti-epileptic drugs (AEDs), and imaging and EEG examination. Results Case 1 was followed up for 28 months, with only one seizure attack occurred due to missing doses. Video EEG (VEEG) during the follow-up period showed that a single unilateral spike-slow wave discharge was found by accident in one year after DBS. As for Case 2, intermittent time was significantly prolonged during the follow-up of 24 months. VEEG during the follow-up period showed interictal right frontal-central-parietal slow wave. Case 3 was followed up for 3 months, and VEEG examination during the follow-up period revealed decrease of diffuse spike-slow wave, while bilateral occipital spike-slow wave could be seen in interictal phase. Without any change of type and dose in taking AEDs after DBS, seizure frequency was reduced by 100% in Case 1, 25% in Case 2, and almost 55% in Case 3. Conclusions DBS therapy is an effective treatment for drug-resistant epilepsy. It could significantly reduce the frequency of attacks, or even completely control the attack, and improve the patients' quality of life. DOI: 10.3969/j.issn.1672-6731.2015.09.007

Objective To explore the clinical value of optic radiation reconstruction in protecting against visual field deficits (VFDs) in anterior temporal lobectomy (ATL). Methods We retrospectively analyzed 24 patients with medically refractory temporal lobe epilepsy undergoing ATL between January 2013 and June 2014. The surgical operations were aided by combining optic radiation reconstruction by diffusion tensor tractography (DTT), microscopy-based neuronavigation and intraoperative MRI (iMRI) techniques. ATL was performed according to the distance between Meyer's loop and temporal pole. The visual fields were examined and seizure outcomes were evaluated by Engel class test in 3-month follow-up. Results The optic radiation was reconstructed in all patients. No bleeding was found in operative site or distant site by iMRI scan. The size of removed temporal lobe was 3.29 cm (1.90-5.10 cm). Visual field testing 3 months after operation showed no VFDs in 16 cases (66.67%) and mild VFDs (< 1/4 quadrant) in 8 cases (33.33% ). One case suffered mild VFD before operation, but did not aggravate after operation. Engel class test showed Engel classⅠin 19 patients (79.17%), class Ⅱ in 4 patients (16.67%) and class Ⅲ in one patient (4.17%). Conclusions For patients with medically refractory temporal lobe epilepsy, the techniques of combining optic radiation reconstruction, microscopy-based euronavigation and iMRI aided in precise mapping could reduce the risk of visual field deficits in anterior temporal lobectomy. DOI: 10.3969/j.issn.1672-6731.2015.09.005

Objective To evaluate the accuracy and safety of deep brain electrode implantation assisted by robotized stereotactic assistant (ROSA) system. Methods A total of 6 epileptic patients who had difficulty in positioning of epileptogenic focus underwent deep brain electrode implantation assisted by ROSA system. Record the maximum and minimum distance of electrode deviation according to postoperative CT and MRI and calculate the average distance, so as to evaluate the accuracy of operation. Record intraoperative electrode related bleeding events, postoperative electrode related bleeding or ischemic events and complications during the follow-up period, so as to evaluate the safety of operation. Results A total of 37 electrodes were successfully implanted in all 6 cases, with a success rate of 100%. Implanted electrodes were mainly located in medial temporal lobe, hippocampus and insular lobe (5 cases) and parieto-lobe (one case). The maximum deviation distance was 8.79 mm, and minimum was 1.14 mm, with an average of (3.65 ± 1.82) mm. Neither intraoperative electrode related bleeding event nor postoperative electrode related bleeding or ischemic event was found. No patient suffered from severe complications, such as intracranial infection, electrode disjunction, undesirable healing of scalp and wound infection, during the follow-up period from 3 to 5 months (mean 3.67 months). Conclusions Deep brain electrode implantation assisted by ROSA system is safe and accurate. DOI: 10.3969/j.issn.1672-6731.2015.09.006

DOI: 10.3969/j.issn.1672-6731.2015.09.001

Neuropathic pain (NP) is a transient dysfunction caused by the damage of peripheral nerve and central nervous system, characterized with hyperalgesia, allodynia and spontaneous pain. Surgical treatment of neuropathic pain has experienced a long process, and plays an important role. This paper reviews recent documents of surgical techniques in the treatment of neuropathic pain. There are three kinds of surgical techniques: neuromodulation, microsurgical lesions and nerve decompression.