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Cranial fixation should be safe, reliable, ideally degradable, and produce no hazardous residues and no artifacts on neuroimaging. Protein-based fixation devices offer an exciting opportunity for this application. Here, the preclinical development and in vivo efficacy verification of a silk cranial fixation system in functional models are reported by addressing key challenges toward clinical use. A comprehensive study on this fixation system in rodent and canine animal models for up to 12 months is carried out. The silk fixation system shows a superb performance on the long-term stability of the internal structural support for cranial flap fixation and bone reconnection and has good magnetic resonance imaging compatibility, and tolerability to high dose radiotherapy, underscoring the favorable clinical application of this system for neurosurgery compared to the current gold standard., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

China currently has the most populous and rapidly aging nation in the world. In the next few decades, China will have to increase the throughput, quality, and scope of its neurosurgical training programs to meet forecasted demand. Until recently, China lacked national education standards in neurosurgery that fostered imbalances in medical and pedagogical resources, quality of care, and education between different regions and introduced significant heterogeneity in neurosurgical competency. In 2010, Shanghai implemented the first new standards-based comprehensive neurosurgery training program, which spans 7 years broken down into 2 blocks. This model was selected subsequently for nationwide adoption by the Chinese Congress of Neurological Surgeons, with initial implementation in 2015 and full nationwide adoption by 2020. Establishment of a national standardized training system represents a significant milestone in the development and evolution of neurosurgery in China and establishes a comprehensive standards-based system that will help reduce nationwide diversity in neurosurgical training. Although this program is still in its infancy and will not see its first graduating class until 2017 in Shanghai, it represents an essential step toward meeting China's growing demand for quality and consistent neurosurgical care. We review the history of neurosurgical training in Mainland China and describe the new Neurosurgical Specialist Standardized Training Program., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Established in 1907, Huashan Hospital affiliated to Fudan University represents in microcosm the growth of modern Chinese medical science and shows its course of development. Over the past 103 years, the hospital has grown from a staff of a dozen to 3103 staff members, covering an area of 37,396 m(2) with 1216 hospital beds. Huashan Hospital has grown into one of the best-known hospitals in China with multiple world-renowned disciplines, including neurosurgery, hand surgery, dermatology, and infectious disease., (Copyright © 2011. Published by Elsevier Inc.)

The Department of Neurosurgery at Shanghai HuaShan Hospital is one of the oldest neurosurgical departments in China and is also one of the country's leading academic neurosurgery programs. The department was established in 1953 under the direction of Yuquan Shi, one of the pioneers and founders of neurosurgery in China, and is currently directed by Liang-Fu Zhou. The HuaShan Neurosurgical Group Hospital and the Shanghai HuaShan Institution of Neurosurgery were established in 2000. The department currently has 67 faculty and 450 beds distributed among one main hospital (HuaShan Hospital) and seven affiliates. More than 8000 neurosurgical procedures are performed annually. The Shanghai Emergency Center of Neurosurgery is also maintained by the department. The Department of Neurosurgery at HuaShan Hospital will continue to grow in strength and position as one of the leaders in the field of neurosurgery.

Chinese processing has been suggested involving distinct brain areas from English. However, current functional localization studies on Chinese speech processing use mostly "indirect" techniques such as functional magnetic resonance imaging and electroencephalography, lacking direct evidence by means of electrocortical recording. In this study, awake craniotomies in 66 Chinese-speaking glioma patients provide a unique opportunity to directly map eloquent language areas. Intraoperative electrocortical stimulation was conducted and the positive sites for speech arrest, anomia, and alexia were identified separately. With help of stereotaxic neuronavigation system and computational modeling, all positive sites elicited by stimulation were integrated and a series of two- and three-dimension Chinese language probability maps were built. We performed statistical comparisons between the Chinese maps and previously derived English maps. While most Chinese speech arrest areas located at typical language production sites (i.e., 50% positive sites in ventral precentral gyrus, 28% in pars opercularis and pars triangularis), which also serve English production, an additional brain area, the left middle frontal gyrus (Brodmann's areas 6/9), was found to be unique in Chinese production (P < 0.05). Moreover, Chinese speakers' inferior ventral precentral gyrus (Brodmann's area 6) was used more than that in English speakers. Our finding suggests that Chinese involves more perisylvian region (extending to left middle frontal gyrus) than English. This is the first time that direct evidence supports cross-cultural neurolinguistics differences in human beings. The Chinese language atlas will also helpful in brain surgery planning for Chinese-speakers. [ABSTRACT FROM AUTHOR]

Background: Resting-state functional magnetic resonance imaging (R-fMRI) is a promising tool in clinical application, especially in presurgical mapping for neurosurgery. This study aimed to investigate the sensitivity and specificity of R-fMRI in the localization of hand motor area in patients with brain tumors validated by direct cortical stimulation (DCS). We also compared this technique to task-based blood oxygenation level-dependent (BOLD) fMRI (T-fMRI). Methods: R-fMRI and T-fMRI were acquired from 17 patients with brain tumors. The cortex sites of the hand motor area were recorded by DCS. Site-by-site comparisons between R-fMRI/T-fMRI and DCS were performed to calculate R-fMRI and T-fMRI sensitivity and specificity using DCS as a 'gold standard'. R-fMRI and T-fMRI performances were compared statistically Results: A total of 609 cortex sites were tested with DCS and compared with R-fMRI findings in 17 patients. For hand motor area localization, R-fMRI sensitivity and specificity were 90.91 and 89.41 %, respectively. Given that two subjects could not comply with T-fMRI, 520 DCS sites were compared with T-fMRI findings in 15 patients. The sensitivity and specificity of T-fMRI were 78.57 and 84.76 %, respectively. In the 15 patients who successfully underwent both R-fMRI and T-fMRI, there was no statistical difference in sensitivity or specificity between the two methods ( p = 0.3198 and p = 0.1431, respectively) Conclusions: R-fMRI sensitivity and specificity are high for localizing hand motor area and even equivalent or slightly higher compared with T-fMRI. Given its convenience for patients, R-fMRI is a promising substitute for T-fMRI for presurgical mapping [ABSTRACT FROM AUTHOR]

Background: By definition, a cavernous sinus is a vascular plexus. A hemangioma is a vascular tumor which is rich in vascular plexus and caused by vascular deformity or tumor-like proliferation. Radiosurgery can effectively control the growth of smaller cavernous sinus hemangiomas (CSHs). This paper aimed to quantify the MRI characteristics of CSHs which provided a basis for further treatment. Methods: A retrospective analysis was conducted of the MRI characteristics of 133 cavernous sinus lesion patients between January 2006 and December 2009, and none of them was diagnosed without histology. Two groups were set apart according to the pathological results: a CSH group (24 patients) and a non-CSH group (109 patients). The latter was further divided into 3 categories: a meningioma group (33 patients), a neurilemmoma group (37 patients) and a miscellaneous group (39 patients). A single-factor χ2 analysis was performed to analyze the data on the 12 MRI characteristics. Results: T2-weighted ultrahigh signal, signal uniformity, dumbbell-like appearance and infiltration of the sellar region were considered statistically significant for the differentiation of CSHs from non-CSHs. If these 4 items served as the diagnostic criteria, the sensitivity, specificity and accuracy was 87.5, 96.3 and 94.7%, respectively. Conclusion: Smaller CSHs can be treated by radiosurgery directly, without performance of a pathological biopsy. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Objective: The study aims to elucidate the advance of diagnosis and surgical treatment of brainstem hemangioblastomas (BSHs). Methods: The data of the following patients treated in one institute were retrospectively analyzed: (1) patients with a single tumor on the brainstem which was verified by surgery and pathology; (2) patients without von Hippel-Lindau disease or multiple hemangioblastomas. Results: Thirty-three patients with BSHs were identified, accounting for 15.5% of all intracranial hemangioblastomas surgically treated from August 1989 to May 2002 in Huashan Hospital. There were 17 males and 16 females. The patients were aged from 16 to 65 years with an average age of 45 years. The clinical manifestations were nonspecific. Magnetic resonance imaging and digital subtraction angiography were the major diagnostic modalities. Tumors were located on oblongata (14), ponto-oblongata (9), pons (6), and cervicomedulla (4). Tumors were solid in 29 cases, cyst in 4 cases, and had a small size in 5 (≤3 cm), large in 19 (3.1-4 cm), and giant in 9 (>4 cm). Extra-brainstem (EBS) type (including the fourth-ventricle hemangioblastomas) was seen in 25 cases, and intrabrainstem (IBS) type in 8 cases. Preoperative embolization was performed in 12 cases since 1996. Mild hypothermia with or without hypotension was done during the operation in 10 cases. Total tumor removal was achieved in 31 patients (94%), and incomplete removal in 2 cases. Two patients with EBS type and giant solid tumors died after operation. Follow-up study (range, 1-12 years; mean, 5 years) was available in 31 patients. Karnofsky performance scale scores were ≥80 in 25 patients (80.6%), 60 to 70 in 4 patients (12.9%), and 40 to 50 in 2 patients (6.5%). Conclusion: Two types of BSHs can be identified. Patients with cystic IBS type could obtain excellent outcome after operations. Patients with giant or large solid BSHs remain a challenge to neurosurgeons. A combined strategy of preoperative embolization, mild hypothermia with or without hypotension, microsurgical technique, and intensive perioperative management are mandatory for removal of these kinds of tumors with acceptable morbidity and mortality. [Copyright &y& Elsevier]

To follow the revision of the fourth edition of WHO classification and the recent progress on the management of diffuse gliomas, the joint guideline committee of Chinese Glioma Cooperative Group (CGCG), Society for Neuro-Oncology of China (SNO-China) and Chinese Brain Cancer Association (CBCA) updated the clinical practice guideline. It provides recommendations for diagnostic and management decisions, and for limiting unnecessary treatments and cost. The recommendations focus on molecular and pathological diagnostics, and the main treatment modalities of surgery, radiotherapy, and chemotherapy. In this guideline, we also integrated the results of some clinical trials of immune therapies and target therapies, which we think are ongoing future directions. The guideline should serve as an application for all professionals involved in the management of patients with adult diffuse glioma and also a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in China and other countries. [ABSTRACT FROM AUTHOR]

Objective The optimal treatment for aneurysmal subarachnoid hemorrhage (SAH) in elderly patients is controversial. Focusing on this specific population, we analyzed early outcomes after endovascular or neurosurgical treatment and developed a prognostic model to aid in clinical decision-making processes. Methods SAH patients aged 60 years or older who underwent active treatment between 2010 and 2013 were retrospectively enrolled in the primary cohort, whereas those treated since 2014 were enrolled in the validation cohort. The Rankin scale and Clavien-Dindo classification for complications were used to measure outcome at 3 months after treatment. The prognostic model for unfavorable outcome was developed based on independent factors derived from multivariate analysis of the primary cohort and examined for prediction accuracy in the validation cohort. Results The primary and validation cohorts were composed of 109 and 64 elderly patients, respectively. There were no significant differences between the 2 cohorts' demographics. An age of 80 years or older, hypertension, frailty, smoking, a high Hunt and Hess grade, multiple aneurysms, and a large aneurysm size served as independent prognostic factors for unfavorable outcome in the primary cohort. The results from the validation cohort demonstrated that these factors were good predictors in the prognostic model. When the risk score was moderate, endovascular intervention presented a more favorable outcome than neurosurgical treatment. Conclusions Because it was proven to be valid in quantitatively predicting treatment efficacy in elderly patients with ruptured aneurysm, the prognostic model is expected to enhance clinical decision-making processes by predicting the treatment-related risk for specific patients. [ABSTRACT FROM AUTHOR]

Background Preoperatively acquired diffusion tensor image (DTI) and blood oxygen level dependent (BOLD) have been proved to be effective in providing more anatomical and functional information; however, the brain deformation induced by brain shift and tumor resection severely impairs the correspondence between the image space and the patient space in image-guided neurosurgery. Method To address the brain deformation, we developed a hybrid non-rigid registration method to register high-field preoperative MRI with low-field intra-operative MRI in order to recover the deformation induced by brain shift and tumor resection. The registered DTI and BOLD are fused with low-field intra-operative MRI for image-guided neurosurgery. Results The proposed hybrid registration method was evaluated by comparing the landmarks predicted by the hybrid registration method with the landmarks identified in the low-field intra-operative MRI for 10 patients. The prediction error of the hybrid method is 1.92 ± 0.54 mm, and the compensation accuracy is 74.3 ± 5.0%. Compared to the landmarks far from the resection region, those near the resection region demonstrated a higher compensation accuracy ( P -value = .003) although these landmarks had larger initial displacements. Conclusions The proposed hybrid registration method is able to bring preoperatively acquired BOLD and DTI into the operating room and compensate for the deformation to augment low-field intra-operative MRI with rich anatomical and functional information. [ABSTRACT FROM AUTHOR]