2025年 · 第11卷第03期

Surgical resection for hypervascular central nervous system tumors poses a significant challenge for neurosurgeons. Controversy remains about the effect and safety of the traditional therapeutic mode, which combines preoperative embolization and delayed tumor resection, remain controversial. Whether a one-stage hybrid operation modality offers a novel approach to address treatment challenges in a safer and more effective way remains unknown.

From the neurosurgical operation database, we retrospectively reviewed patients with hypervascular central nervous system tumor patients who underwent one-stage hybrid operation between January 1, 2014, and September 30, 2024. Intraoperative blood loss, the percentage of tumor devascularization, and complications associated with embolization were recorded. Novel embolization strategies used to facilitate the resection of tumors in one-stage hybrid operations were analyzed.

In total, 31 hypervascular central nervous system tumor patients were recruited. The main pathological types included various types of meningiomas (45.2%), hemangioblastomas (16.1%), paragangliomas (9.7%), and solitary fibrous tumors (9.7%). Embolization of tumor-feeding arterial pedicles alone was achieved in 25 patients, and various materials, such as ethylene-vinyl alcohol copolymer, Guglielmi detachable coil, and silk suture segments, were used, in which the tumor blood supply was blocked satisfactorily and the texture became softer postembolization. Intratumoral vascular beds were embolized in six patients. The mean occlusion rate of the target pedicle was 83.3%. Gross-total resection was achieved in 22 patients (71.0%), with a mean blood loss volume of 1127 ± 1114.4 mL (ranging from 150 - 4500 ml). No embolization-related complications occurred. Deterioration of neurological deficits was observed in three patients (9.7%) at discharge.

A one-stage hybrid operation is safe for the treatment of hypervascular central nervous system tumors. A prospective study to evaluating its safety and efficacy compared with separate-stage treatment is needed.

Absorbable cranial flap fixation products, represented by Aesculap^® CranioFix absorbable clamp, are widely used in neurosurgery. However, the product has some shortcomings, as it is not entirely biodegradable, the lower disc’s angle cannot be adjusted, and there is a failure to readjust after fixation. To address these issues, MedArt Technology Co., Ltd. from China has come up with a high-purity PLLA combined with an innovative structural design to develop a novel cranial flap fixation system that is more convenient to operate, has a better resetting effect, and can be fully absorbed. This study aims to verify its safety and effectiveness through in vitro experiments and clinical trials.

In this study, the absorbable cranial flap fixation system of MedArt was used as the experimental group, and the CranioFix absorbable clamp constituted the control group. The material properties and the changing trend of mechanical properties of the two groups were compared by accelerated degradation experiments in vitro. A multicenter, randomized, parallel, positive-controlled, non-inferiority clinical study was conducted with a 48-week follow-up. The shortening degree of the bone flap gap, qualified rate of bone flap displacement, changing trend of implant volume, and occurrence of postoperative adverse events were compared between the two groups.

The results of the in vitro accelerated degradation showed that in terms of the decrease in intrinsic viscosity, the control and experimental groups took 7 days and 14 days, respectively, to reach the test endpoint. For mechanical properties, the control group and experimental groups lost clinical safety fixation significance on the 3rd and 4th day after the degradation began, respectively. Regarding the release of degradation products, the control group showed a burst of lactic acid release during the first 3-7 days, while the experimental group released lactic acid slowly and constantly. In the clinical study, 90 patients were randomly enrolled, 87 of whom completed the operation, with an average age of 50. The 3D reconstruction of CT images showed that the bone flap gaps in both groups were less than 2 mm after surgery. The qualified rate of bone flap displacement in the experimental group was 100% after surgery. In contrast, in the control group, there was one unqualified case at 1 week after surgery and two unqualified cases at 6 weeks, 12 weeks, 24 weeks, and 48 weeks. The residual volume of the implant in the experimental group was closer to 50% (about 48.8%) 48 weeks after surgery, than in the control group (about 43.9%) 12 weeks after surgery. Regarding safety, only one possible device-related adverse event occurred in the control group, with an incidence rate of 2.22%, manifested as poor healing at the incision site.

The study has verified that the experimental group had better stability, longer biodegradation time, and better mechanical properties than the control group. Moreover, the experimental group could significantly narrow the cranial flap gap, reduce the flap displacement, and promote skull healing after craniotomy. It shows a fairly reliable fixation effect and safety.

Chondrosarcoma is a rare and malignant tumor in the sellar region. Due to the limited understanding of its oncological behavior, it is often misdiagnosed as other lesions, such as chordoma or invasive pituitary adenoma. In the past, craniotomy was considered the primary treatment option. However, with the advancement of neuroendoscopic techniques, many centers have begun adopting endoscopic approaches for this disease. In this article, we summarized our case series and reviewed the previous papers to evaluate the clinical outcomes of neuroendoscopic resection for sellar chondrosarcomas.

Four patients with sellar chondrosarcomas who underwent tumor resection by endonasal endoscopic approach (EEA) in our institute from 2017 to 2021 were reviewed. In addition, we reviewed the current literatures on sellar chondrosarcomas.

Our series included 4 patients, and 8 cases of sellar chondrosarcomas were reported in previous literatures. In the pooled cohort, there were 6 males and 6 females. The median age at diagnosis was 28.5 years (interquartile range, 22.8-39.3). The most common clinical presentation was blurring of vision (66.7%) and headache (50%). The incidence of preoperative endocrine disorder in such patients was 33.3%; these abnormalities could return to normal after surgery. Complete resection and incomplete resection were achieved in 7 (58.3%) and 5 (41.7%) cases, respectively. Among the 12 patients, only one patient was diagnosed with chondrosarcoma preoperatively; other patients were misdiagnosed with chordoma (n = 5; 41.7%), invasive non-functioning pituitary adenoma (INPA) (n = 4; 33.3%), or craniopharyngioma (n = 2; 16.7%).

The preoperative diagnosis of sellar chondrosarcoma remains challenging and often requires differentiation from chordoma, INPA, or craniopharyngioma. When a calcified mass in the sellar region presents with intact or slightly disturbed anterior pituitary function, heterogeneous enhancement and no diffusion restriction on Magnetic Resonance Imaging(MRI) sequences, and surrounding bony destruction and bony attachment on Computed Tomography(CT) scans, a chondrosarcoma should be suspected preferentially. Complete resection is the optimal goal for the management of sellar chondrosarcoma, but adjuvant radiotherapy and periodic follow-up should be highlighted.

Brain abscess (BA) is a serious condition that causes significant mortality and morbidity. While various prognostic factors have been studied, there is limited research on long-term survival predictions. The present study aimed to identify predictors of long-term survival in BA patients and develop a dynamic nomogram for individualized prognostication. Additionally, the secondary objective was to develop and validate a dynamic nomogram for predicting long-term survival in BA patients.

A retrospective cohort study was conducted on BA patients diagnosed at a tertiary care hospital in Southern Thailand. Demographic, clinical, laboratory, and imaging finding were analyzed. Cox regression was used to identify independent prognostic factors. A dynamic nomogram was developed and validated using Harrell’s concordance index (C-index), calibration plots, and cumulative case/dynamic control survival receiver operating characteristic (ROC) curves.

A total of 205 patients were included, with a mean follow-up of 41.66 months. The 1-year, 2-year, and 5-year survival probabilities were 0.77, 0.73, and 0.69, respectively. Independent predictors of long-term survival included age, Karnofsky performance status, hemoculture results, preoperative coagulopathy, neutrophil-to-lymphocyte ratio, bandemia, and occipital BA. The dynamic nomogram revealed strong predictive performance, with a C-index of 0.855 for apparent validation and 0.701 for validation with testing data. Calibration plots and ROC analysis further supported its reliability.

This study presents a validated dynamic nomogram for predicting long-term survival in BA patients. The model provides an interactive tool for individualized risk assessment and facilitating clinical decision-making. Future research should focus on external validation and refinement of the model for broader applicability.

Deep learning (DL) based on MRI of medulloblastoma enables risk stratification, potentially aiding in therapeutic decisions. This study aims to develop DL models that identify four medulloblastoma molecular subgroups and prognostic-related genetic signatures.

This retrospective study enrolled 325 patients for model development and an independent external validation cohort of 124 patients, totaling 449 MB patients from 2 medical institutes. Consecutive patients with newly diagnosed MB at MRI (T1-weighted, T2-weighted, and contrast-enhanced T1-weighted) at two medical institutes between January 2015 and June 2023 were identified. Two-stage sequential DL models were designed—MB-CNN that first identifies wingless (WNT), sonic hedgehog (SHH), Group 3, and Group 4. Further, prognostic-related genetic signatures using DL models (MB-CNN_TP53/MYC/Chr11) were developed to predict TP53 mutation, MYC amplification, and chromosome 11 loss status. A hybrid model combining MB-CNN and conventional data (clinical information and MRI features) was compared to a logistic regression model constructed only with conventional data. Four-classification tasks were evaluated with confusion matrices (accuracy) and two-classification tasks with ROC curves (area under the curve (AUC)).

The datasets comprised 449 patients (mean age ± SD at diagnosis, 13.55 years ± 2.33, 249 males). MB-CNN accurately classified MB subgroups in the external test dataset, achieving a median accuracy of 77.50% (range in 76.29% to 78.71%). MB-CNN_TP53/MYC/Chr11 models effectively predicted signatures (AUC of TP53 in SHH: 0.91, MYC amplification in Group 3: 0.87, chromosome 11 loss in Group 4: 0.89). The accuracy of the hybrid model outperformed the logistic regression model (82.20% vs. 59.14%, P=.009) and showed comparable performance to MB-CNN (82.20% vs. 77.50%, P = 0.105).

MRI-based DL models allowed identification of the molecular medulloblastoma subgroups and prognostic-related genetic signatures.

The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (US) populations as do the plaque features on imaging.

The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and US patients.

Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10-µm thickness) at 0.5-1 mm intervals. Hematoxylin and eosin staining and Mallory’s trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups.

A total of 1152 histological sections from 75 Chinese patients and 1843 sections from 111 US patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p = 0.046) and a larger percent wall volume (median: 74% vs. 70%, p = 0.018) than the US group. After adjusting for confounding factors, carotid plaques in the Chinese population had larger lipid pools (β = 10.0%, 95% CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β = 8.4%, 95% CI: 4.5 to 12.7%), less late IPH (β = - 8.2%, 95% CI: - 11.3 to - 5.4), and fewer fibrous cap disruptions (45% vs. 67%, p = 0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did US plaques (20% vs 2.7%, p < 0.001).

The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which indicates a need for a different management approach.

Intracranial aneurysm(IA) are among the most common cerebrovascular diseases, and their rupture can lead to severe consequences. Aging plays a significant role in the onset and progression of many diseases, yet it remains understudied in the context of intracranial aneurysms. The aim of this study is to investigate the role of aging-related genes in the development of intracranial aneurysms using public databases, in order to understand the underlying biological mechanisms.

Gene expression profiles for intracranial aneurysms were downloaded from the GEO database. Human aging-related genes were obtained from the HAGR website. Differentially expressed gene analysis and WGCNA were used to identify core hub genes. GO and KEGG enrichment analyses were conducted to determine the potential biological functions and pathways that these differentially expressed aging-related genes in intracranial aneurysms might be involved in. Based on the hub genes, co-expression gene networks and Gene-TF-miRNA regulatory networks were constructed. Further exploration of drug-gene interactions was conducted to screen potential target drugs.

Through the intersection of aging-related genes and differentially expressed genes in IA, 32 common differentially expressed genes were identified, with 20 genes upregulated and 12 genes downregulated. GO enrichment analysis showed that these genes were mainly involved in epithelial cell proliferation and regulation, peptide enzyme activity modulation, and metabolic Homeostasis. KEGG enrichment analysis showed that these genes were primarily involved in the adipocytokine signaling pathway, growth Hormone synthesis,secretion and action, neurotrophin signaling pathway, and longevity regulating pathway. WGCNA was used to identify genes highly correlated with the IA phenotype, and an intersection with the 32 differentially expressed aging-related genes yielded 11 candidate Hub DEARGs. The expression of the candidate Hub DEARGs was validated using an external dataset, ultimately confirming 4 hub DEARGs related to intracranial aneurysms. Among them, NGFR and ADCY5 were downregulated, while BUB1B and SERPINE1 were upregulated.

This study identified four aging-related genes, NGFR, ADCY5, SERPINE1, and BUB1B, that are associated with intracranial aneurysms. This provides new insights into the molecular mechanisms underlying the development of intracranial aneurysms. The identified core genes provide promising leads for further experimental research to explore the pathogenesis of the disease.

Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the central nervous system, typically resulting from an imbalance between CSF production and absorption. Traditional classifications of hydrocephalus do not incorporate management strategies (not classified according to the degree of difficulty of treatment). Clinically, hydrocephalus that is challenging to treat is often categorized as refractory hydrocephalus (RH). However, the absence of a unified definition of RH impedes the standardization of treatment approaches, raising clinical dilemmas. This article explores the definition, etiologies, classification, and management strategies for RH. Based on the literature and the Diagnosis-Related Group payment system principles, RH is clinically defined as progressive hydrocephalus meeting one or more of the following criteria: (1) the absence of significant clinical or radiological improvement within 60 days despite standard interventions, usually due to pathological factors, such as abnormal CSF characteristics, (2) inability to achieve curative surgical treatments attributable to complex anatomy such as abnormal dynamic changes or multiloculated compartments, and (3) failure to respond after two consecutive therapeutic procedures. RH consists of six distinct subtypes, with infectious hydrocephalus being the most common, followed by low-pressure hydrocephalus. Temporary management strategies for RH must be carefully tailored to patient-specific characteristics, considering the risk-benefit analysis of available measures. In cases of infectious RH, achieving CSF sterilization and evaluating the results are crucial. Curative surgery for infectious RH should be performed only after CSF has been completely sterilized to normal levels. In low-pressure RH, a critical focus is identifying and addressing the sites receiving CSF.