Over the past few decades, majority of neurosurgeons only specialize in spinal cord diseases. However, with the advances in spine surgery, more and more neurosurgeons focus on spine diseases. Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery. As traditional surgery has been gradually replaced by precision surgery, open surgery has been gradually replaced by minimally invasive surgery (MIS), the diagnosis and treatment of spine diseases has been benefiting from minimally invasive techniques. With minimal surgical trauma, precise localization, MIS has become the inevitable trend of new neurosurgery. The model of multi-disciplinary team is gradually becoming universal in the world in order to make the best treatment plan for the patient with spine diseases on the basis of the comprehensive disciplinary opinion.

Spinal ependymomas (SEs) are common adult intramedullary tumors;however, determining the absolute boundary between the tumor and the tumor residual may be difficult.We assessed outcomes following the use of fluorescein sodium (FS) during surgical removal of SEs.We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016.Each patient received intravenous FS (3-4 mg/kg) to determine the SE boundaries during surgery.Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging (MRI) at 10 days and 3 months after surgical recovery;McCormick's spinal function classification was also performed at the 3-month follow-up.The complete tumor removal rate was 92%(103/112).Ninetyfour patients underwent tumor removal under fluorescent light,which provided distinctive tumor fluorescence.Tumor removal under white light was performed in 18 patients;fluorescent images were invisible or indistinctive in these 18 patients.At the 3-month follow-up,sensory function (85.8%(91/106)) and movement (84.3% (86/102)) were improved in patients with pre-surgical dysfunction;urination and defecation functions were improved in 66.7%(16/24).The McCormick spinal cord functional classifications,at the 3-month follow-up,showed significant differences in the percentages of patients with disease classified to each grade (I-IV),compared with preoperative classifications (each,P<0.05).There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up.FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion (32 cases) and thoracic/lumbar/sacral spine fixation (28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body, yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20-30 min/time. Screw implantation times were 5-7 min (cervical spine), 8-10 min (thoracic spine), and 6-8 min (lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Objectives: Ganglioneuroma is a rare,benign neurogenic tumor arising from the sympathetic ganglia.In this report,we reviewed and summarized the clinical features, treatment,and prognosis of a posterior mediastinal ganglioneuroma.
Case:Here,we report on a 29-year-old man referred to us with transient pain in the right side of the chest,lasting for three days.Physical examination revealed no abnormalities. The results of routine laboratory tests were within the normal ranges.Thoracic spinal magnetic resonance imaging showed a well-defined,solid mass in the right paravertebral region at the T5-T8 level,measuring 7.5 cm×4.2 cm×1.5 cm.To accurately locate the lesion during surgery,O-arm intraoperative imaging was used in conjunction with the Stealth Station navigation system.The tumor was completely excised and no related complications occurred.The tumor was an encapsulated mass with a solid,homogenous,grayish-tan cut surface.Histopathological examinations confirmed that the mass was a ganglioneuroma.
Conclusions:Ganglioneuroma is a rare,benign tumor.Prior to treatment,a careful imaging evaluation is necessary in order to obtain an accurate diagnosis.A definitive diagnosis can be made by histological examination.En bloc resection is the preferred treatment for ganglioneuroma as it has an excellent prognosis.

Schwannomas are the most common type of spinal tumor, and they most commonly occur in intradural extramedullary locations. Intramedullary schwannomas of the central nervous system are very rare and are difficult to diagnose using preoperative imaging. Here, we report a rare, tiny cervical intramedullary schwannoma and review the literature regarding the clinical presentation, magnetic resonance imaging, pathology, and surgical experience associated with this rare tumor type.

Mesenchymal stromal/stem cells (MSCs) are multipotent cells under consideration as a potential new therapy for a variety of inflammatory diseases including certain neurological disorders. It is generally thought that the efficacy of cell therapy in attenuating damage after ischemia, inflammation, or injury depends on the quantity of transplanted cells recruited to the target tissue. However, only a small number of systematically infused MSCs can effectively migrate to target sites, which significantly decreases the efficacy of exogenous cell-based therapy. In this review, we discuss specific factors influencing MSC migration, and summarize current strategies that effectively promote the motility of MSCs. In addition, we describe several protocols to improve the migration of stromal cells into the nervous system and, therefore, enhance the efficiency of engraftment as means of treating neurological disorders.

In recent years, China's population has shown an obvious aging trend. This trend has been accompanied by an increased incidence of cardiovascular disease and death. Intracranial stenting has become an important treatment modality for intracranial vascular disease because it is effective, safe, and widely approved. In this paper, we review the literature concerning the classification, structure, preparation, and performance of intracranial stents. We also summarize problems and future prospects in the context of intracranial stents. This paper will serve as a reference for the future research and development of intracranial stents.