To investigate the clinical effect of selected-peripheral-neurotomy under electromyography monitoring in the treatment of spastic cerebral palsy.

Sixty five patients with spastic cerebral palsy who underwent selected-peripheral-neurotomy surgery in Department of Neurosurgery of Aviation General Hospital from January 2018 to June 2020 were included. Surface electromyography (sEMG) and modified Ashworth scale (MAS) were used to evaluate the target spastic muscle group before operation. The nerve branches of target spastic muscle group were narrowed during operation. sEMG, MAS grading, kinematic parameters (walking speed, frequency, step length, step width, foot angle), ADL score and Fugl-Meyer motor function score were used to evaluate the patients’ living ability and motor function.

A total of 193 peripheral nerve tracts were constricted in 65 patients with spastic cerebral palsy. The decrease rate of muscle tension was 100% in perioperative period and the normal rate of muscle tension was 92.75% in postoperative period. There was significant difference in SEMG before and 7 d after operation (P<0.05). Compared with preoperative, walking function, activities of daily living and motor function were significantly improved in perioperative period (P<0.05). The incidence of decreased muscle strength of quadriceps femoris during perioperative period was 16.67% (2/12). Muscle strength recovered during follow-up.

Selected-peripheral-neurotomy constriction was used to treat spastic cerebral palsy. Before operation, sEMG was used to determine the target muscle group. During operation, electromyography monitoring and stimulating electromyography data quantitative guidance were used. The nerve branches of the spastic muscles in the target muscle group were given narrowing operation under the microscope. These were effective surgical methods to reduce muscle tension, and had obvious effect on improving walking, motor ability and activities of daily living of patients with spastic cerebral palsy.

To study the therapeutic effect of botulinum toxin serotype A (BoNTA) in the treatment of chronic migraine (CM).

A retrospective analysis was performed on 47 patients with CM admitted to the Department of Neurosurgery, Chengdu 363 Hospital from June 2018 to June 2019. All patients were treated with BoNTA. The severity of pain and the number of pain episodes per month were compared by preoperative and postoperative questionnaires.

The average pain incidence reported by the patients before operation was 12(9,16) times per month, but the average pain incidence reported by the patients after operation was reduced to 3(1,5) times per month. The mean pain score also decreased from 7(7,8) points before surgery to 1(1,5) points after injection. Eleven patients reported pain free after injection, 28 patients reported significant relief of pain, 3 patients reported effective relief of pain, and only 5 patients reported no significant postoperative improvement. The mean follow-up time was 11.06 months.

BoNTA is a feasible and promising treatment for CM.

To investigate the efficacy and safety of Hoffmann’s endoscopic ulnar neurolysis in the treatment of cubital tunnel syndrome.

The clinical data of 13 patients with cubital tunnel syndrome who underwent endoscopic ulnar neurolysis from June 2016 to September 2020 in the First Hospital of Peking University were analyzed retrospectively. The surgical instrument was the cubital release kit, and Professor Hoffmann’s method was used in the operation. McGowan classification was used to classify the patients before operation. The patients were followed up by telephone and outpatient department after operation and evaluated by modified Bishop score.

Among the 13 cases, 11 cases underwent ulnar nerve decompression alone, 2 cases with small cyst compression underwent cyst resection at the same time. Postoperative pathology showed that 1 case was synovial cyst of elbow joint and 1 case was ganglion cyst. All patients were discharged from the hospital 2-5 d postoperatively. One patient had incision dehiscence and healed well after suturing again. The other patients had no complications. Numbness was relieved in all patients on the second day after operation. After 5-56 months of follow-up, the modified Bishop score was excellent in 5 cases, good in 5 cases, fair in 3 cases and poor in 0 case. The excellent and good rate of modified Bishop score was 100% (6/6) in McGowan grade 1 group and 57% (4/7) in McGowan grade 2 group. All the patients returned to work in 14-21 d after surgery.

Endoscopic cubital tunnel decompression is a minimally invasive surgery, the effect of nerve decompression is equivalent to that of open surgery, with less postoperative short-term complications and quick recovery, especially suitable for patients with primary cubital tunnel syndrome.

To evaluate the efficacy and safety of selective posterior rhizotomy (SPR) through interlaminar approach in the treatment of spastic paralysis of lower limbs.

The clinical data of 20 patients with spastic paralysis of the lower extremities treated by SPR through interlaminar approach, admitted to Neurosurgery Department of Yuquan Hospital of Tsinghua University from July 2019 to April 2020, were retrospectively analyzed. The patients were followed up for 1 year. The general data, modified Ashworth score (MAS) and gross motor function classification system score (GMFCS) before and after surgery were analyzed.

All the 20 patients completed the operation of interlaminar approach. The scores of MAS and GMFCS were significantly improved after operation.

Interlaminar approach has no damage to the bony structure, less impact on the stability of the spine, and does not increase the risk of operation, so it is a more reasonable operation to expose the nerve root.

To investigate the surgical treatment of lateral flexure spasmodic torticollis (ST).

From June 2014 to June 2019, 25 patients with lateral flexure ST were treated in the Departments of Neurosurgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology. Preoperative electromyography and CT (or MRI) examination were used to determine the main spastic muscles. Among them, 23 cases of them underwent standard triple operation combined with scalenus ablation, while 2 cases only underwent scalenus ablation surgery. Postoperative efficacy was assessed 6 months after surgery.

Seventeen cases (68%) were cured, 5 cases (20%) were markedly effective, and 3 cases (12%) were improved, 0 case (0%) ineffective with no death, no disability and no serious complications.

Standard triple operation combined with spastic scalenus ablation was a safe and effective method for the treatment of lateral flexure ST.

To evaluate the value of Guyon’s canal decompression in the treatment of diabetic peripheral neuropathy with (DPN) microsurgery.

Eleven patients (14 sides) with upper extremity DPN, admitted to Neurosurgery Department of China-Japan Friendship Hospital from March 2019 to March 2020, underwent microsurgical decompression of the Guyon’s canal, 7 of whom underwent unilateral ulnar nerve decompression of the cubital canal. The ulnar nerve decompression of the cubital canal and Guyon’s canal were performed in 4 patients, 3 patients were bilateral and 1 patient was unilateral. Postoperative follow-up was conducted to observe the improvement of sensory dysfunction (hand numbness, pain), motor dysfunction and two-point discrimination perception.

All patients were followed up for an average of 12 months. In 11 patients with upper extremity DPN, numbness was relieved by 85.71% (12/14), pain was relieved by 100% (14/14), dyskinesia was improved by 71.43% (10/14), and little finger discrimination was improved by 85.71% (12/14).

The ulnar nerve entrapment in the Guyon’s canal is easy to be neglected in DPN and should be paid enough attention in clinical practice. The ulnar nerve decompression in the Guyon’s canal plays an important value in upper extremity DPN.

To investigate the clinical characteristics and the selection of surgical approach for medulloblastoma (MDB) in children.

Retrospective analysis of clinical data of 32 children with MDB who were treated by cerebellar medullar fissure (CMF) approach (including 28 cases of unilateral cerebellar medullar fissure approach and 4 cases of bilateral CMF approach) from January 2011 to December 2019 in Neurosurgery Department of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital. The clinical features and prognosis of the patients were analyzed.

Among 32 cases, 28 patients (87.5%) were <10 years old, 21.9% were <3 years old and 65.6% were male. The longest duration of the disease in all patients was 6 months, and 71.9% cases were within 3 months, the main symptoms were intracranial hypertension and ataxia. Most of the MDBs were located in vermis or midline (90.6%), only 9.4% in cerebellum hemisphere, and 9.4% of MDB oppressed brain stem. The total resection rate was 90.6% in 29 patients, 3 patients were subtotal resection, 1 patient was complicated with cerebellar mutism, full recovery was achieved after 1 month. There were no surgical related deaths and no permanent cerebrospinal fluid leakage.

CMF approach is the optimal surgical approach for MDB, which is in line with minimally invasive surgery principles. Mastering the clinical features of MDB and the principles and skills of CMF approach, combined with the exquisite minimally invasive neurosurgery techniques, contributes to improving the curative effect of MDB.

To study the starting time of school learning activities in patients with drug-resistant epilepsy (DRE) after surgery, and to analyze the influence of early or late starting time of school learning on the surgical efficacy.

A total of 84 patients who diagnosed with DRE after surgery in Functional Neurosurgery Department of Shanghai Blue Cross Brain Hospital from June 2011 to January 2019 were retrospectively enrolled. The correlation between different starting time of school learning activities and postoperative seizure frequency as well as the effect of surgery.

(1) For predicting epileptic seizure, starting time of school learning activities displayed an excellent areas under the ROC curve (area under curve=0.838, P<0.001), when the cut-off was 3.5 months, the Youden index was 0.57, sensibility was 79.1% and specificity was 78.1%. (2) Compared with starting of school learning activities late group patients (>3.5 months), early group patients were older, lower proportion of male, and lower Engel grade and epileptic seizure. (3) The starting time of school learning activities was significantly positive correlated with number of seizures (r=0.613, P<0.001) as well as Engel grade (r=0.334, P<0.001).

The DRE patients can be well controlled by early and suitable surgical treatment. For the patients who are in the learning period after operation, it is of positive significance to start the learning time in school early to consolidate the curative effect of operation and restore the normal social function of patients.

To investigate the selection and efficacy of deep brain stimulation (DBS) in the treatment of Meige syndrome.

The clinical data of 6 patients with Meige syndrome who underwent DBS therapy with different targets in the Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2020 were retrospectively studied. The dystonia motor rating scale (BFMDRS) was used to evaluate the therapeutic effect.

The improvement rates of BFMDRS motor symptom scores in 6 patients with simple blepharospasm and (or) corner of mouth convulsion were all more than 60%. There were no major complications such as intracranial hematoma and electrode rupture. The CT electrodes of the head were located in the target.

Bilateral DBS is safe and effective for the treatment of Meige syndrome.