2026年 · 第12卷第02期

Background Brain arteriovenous malformation (bAVM) is a rare vascular disorder that can lead to severe neurological symptoms. The molecular mechanisms driving bAVM development and progression of bAVM remain poorly understood. This study aimed to investigate the molecular changes potentially associated with bAVM pathogenesis by performing RNA-seq on human microvascular endothelial cells (HMEC-1) overexpressing KRAS, a key driver of BAVM. Results HMEC-1 cells overexpressing KRAS were established as an in vitro model of bAVM. RNA-seq were conducted and transcriptomic analysis revealed that differentially expressed genes in HMEC-1 cells overexpressing KRAS were predominantly enriched in pathways related to cell adhesion, signaling, and transport, which may contribute to bAVM pathogenesis. Specifically, upregulated genes were mainly located in the cell-substrate junctions and focal adhesion, whereas downregulated genes were primarily located in the ribosomal subunits, ribosome, mitochondrial protein complex, and mitochondrial inner membrane. Conclusions Our findings provided a preliminary delineation of molecular mechanisms after KRAS overexpression in endothelial cells, which may contribute to the development of bAVM. Future work will focus on validating these results in clinical specimens, functionally characterizing the dysregulated pathways, and exploring their potential as novel therapeutic targets.

Background Endovascular treatment (EVT) for basilar artery trunk aneurysm (BTA) is inadequately studied due to its rarity. The aim of this study was to report our experience regarding treatment modalities, complications and outcomes. Methods A retrospective analysis of 2759 aneurysm patients who underwent EVT between January 2018 and December 2022 was performed. Patients with BTAs were involved, and their clinical characteristics, treatment modalities, complications, and clinical and angiographic outcomes were collected. Literatures from 2013 to 2024 were reviewed and studies included more than 5 BTA cases were summarized. Results Thirty-seven patients were involved, including 6 (16.2%) patients with ruptured BTAs. Treatment modalities included simple coiling for 5 (13.5%) patients, traditional low-metal-coverage stent for 1 (2.7%) patient, stent-assisted coiling for 20 (54.1%) patients, and flow diverter (FD) for 11 (29.7%) patients. Four (10.8%) procedure-related complications occurred, including 1 (2.7%) hemorrhage and 3 (8.1%) ischemia cases. The last angiographic follow-up (mean 9.5 ± 8.6 months) of 32(86.5%) patients showed complete occlusion in 23 (71.8%) patients, near-complete occlusion in 6 (18.8%) patients, and incomplete occlusion in 3 (9.4%) patients. Clinical follow-up (mean 33 ± 18.6 months) showed mRS 0-2 in 33 (89.2%) patients and mRS ≥ 3 in 4 (10.8%) patients, including 2 deaths. Large BTAs tended to be a risk factor for procedure-related complications(p = 0.08) and unfavorable clinical outcomes(p = 0.08). Conclusions Traditional coiling and stent-assisted coiling were still the dominant methods for BTAs, supplemented by FD for some complicated conditions such as large/giant or fusiform BTAs. Large size tends to pose additional risks for EVT.

Background Revascularization is the main effective treatment for moyamoya disease Moyamoya disease (MMD) but is associated with a high risk of postoperative cerebral infarction. We aimed to analyze the correlation between lesions in intracranial major arteries and postoperative cerebral infarction. Methods Adult patients with ischemic MMD were enrolled in this analysis from June 1, 2021, to October 31, 2024. The preoperative clinical characteristics and features of digital subtraction angiography were recorded. Postoperative computed tomography or magnetic resonance imaging was performed to identify infarction complications. The Suzuki stage and lesions of the intracranial major arteries were analyzed to determine their correlations with postoperative cerebral infarction. Results A total of 119 adult patients with ischemic moyamoya disease were included in the final analysis. When the degree of stenosis was considered a disordered variable and the normal artery was taken as the reference, the logistic regression analysis showed that severe stenosis of the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) was significantly correlated with postoperative infarction (ICA (OR, 8.833; 95% CI, 0.730-106.821; p = 0.046), ACA (OR, 49.500; 95% CI, 5.083-482.011; p = 0.001), MCA (OR, 24.000; 95% CI, 1.459-394.881; p = 0.026), and PCA (OR, 54.333; 95% CI, 4.307-685.462; p = 0.002)). Digital subtraction angiography (DSA) was performed on three patients with postoperative cerebral infarction and showed acute occlusion or aggravated stenosis of the major intracranial arteries with severe preoperative stenosis. Conclusions Severe stenosis of major intracranial arteries is an important risk factor for cerebral infarction after combined revascularization in adult patients with ischemic MMD.

Background Flow diverter devices (FDDs) have revolutionized the treatment of intracranial aneurysms. However, comprehensive long-term outcome data across multiple device platforms remain limited, with most prior studies focusing exclusively on Pipeline embolization device (PED) outcomes. This study reports extensive long-term clinical follow-up of patients treated with various types of FDDs, providing critical safety and efficacy data for contemporary practice. Methods We conducted a retrospective analysis of intracranial aneurysms treated with FDDs from February 2011 to July 2016 in two tertiary care centers in France. The study included 209 patients with 216 cerebral aneurysms (91.2% anterior circulation, 8.8% posterior circulation; 66.2% unruptured, 31.0% recanalized, 2.8% ruptured). The duration of clinical and angiographic follow-up ranged from 24 to 156 months. Kaplan-Meier analysis performed for complication-free survival and aneurysm occlusion durability. Multivariate analysis showed risk factors for delayed complications. Results Long-term follow-up data were available for 202/209 (96.7%) patients. The early permanent morbidity and mortality rates were 3.8% and 1.4%, respectively. Between 12 and 18 months, procedure-related complications occurred in 5 of 202 patients (2.5%): two ischemic events, one delayed rupture, one silent intrastent stenosis, and one case of seizures following antiplatelet withdrawal. Only three patients (1.5%) were symptomatic. At the 24-month follow-up, complete aneurysm occlusion achieved in 81.0% of the patients, with adequate occlusion in 93.3%. Kaplan-Meier analysis revealed 97.5% complication-free survival at 18 months, with sustained durability thereafter. Multiple FDDs were the only significant independent predictor of delayed complications (OR: 7.066, 95% CI: 1.049-47.606, P < 0.045). No procedure-related complications or deaths occurred after 18 months. Conclusion Beyond 18 months of follow-up, FDD treatment for intracranial aneurysms proves exceptional safety with no delayed complications, regardless of device type. However, the findings of this study also show 18 months as a critical threshold for complication risk assessment, a key implication that clinicians and researchers need to be aware of. The study also underscores the need for modified management strategies when multiple overlapping FDDs are deployed, which significantly increases the risk of delayed complications.

Background The IDH-mutant low-grade glioma (LGG) involving corpus callosum (ccLGG) is a rare type of LGG which has a poorer prognosis. To evaluate the efficacy of multimodal techniques (comprising neuronavigation, intraoperative MRI, and neuromonitoring) compared with the conventional approach guided solely by neuronavigation in the resection of IDH-mutant ccLGG, and to identify prognostic factors of ccLGG. Methods The IDH-mutant ccLGG cases that received resection in our center between 2014 and 2022 were collected and reviewed retrospectively. Comparisons were made between the multimodal and conventional groups regarding patient demographics, tumor characteristics, extent of resection (EOR), neurological function, Karnofsky Performance Status (KPS), progression-free survival (PFS), and overall survival (OS). Both univariate and multivariate analysis were employed to assess potential prognostic factors. Results Ultimately, 64 patients in the multimodal group and 34 in the conventional group were enrolled. Compared with the conventional group, the multimodal group achieved a significantly higher median EOR (100% vs. 93.55%, P = 0.001) and a greater gross total resection (GTR) rate (62.5% vs. 35.3%, P = 0.010). No significant differences were observed in postoperative neurological function or KPS between the two groups at any of the time points assessed. Compared with the conventional group, the multimodal group demonstrated significantly longer median PFS (78.5 vs. 48.1 months, P = 0.010) and OS (106.1 vs. 66.9 months, P = 0.009). Non-butterfly ccLGG, less tumor volume, genu invasion of CC (compared to splenium invasion), less volume of CC invasion, higher EOR, longer chemotherapy cycles of Temozolomide (TMZ), higher KPS on 3 months and MGMT methylation were positive factors for PFS of ccLGG. While four factors were associated with the longer OS of ccLGG, including genu of CC invasion compared to both genu and body invasion of CC, higher EOR, longer TMZ cycles and MGMT methylation. Conclusion Multimodal techniques are useful for achieving maximal safe resection and better prognosis of ccLGG. As higher EOR independently predicts improved survival in IDH-mutant ccLGG, maximal safe resection should be suggested and achieved by appropriate means tailored to available resources. The postoperative chemotherapy should also be recommended to patients with high risks. While whether postoperative radiotherapy should be performed should consider and balance many factors.

Prolactinomas are the most prevalent functional pituitary adenomas. Significant advancements have been made in the diagnostic and therapeutic concepts for prolactinomas, driven by progress in surgical techniques and the accumulation of new clinical evidence-based medicine. Based on the 2014 version of the "Chinese Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma," the China Pituitary Adenoma Specialist Council has revised this consensus in accordance with the latest evidence-based medical finding and clinical experience, aiming to provide standardized diagnosis and treatment recommendations for clinicians. The consensus systematically elaborates on the epidemiological characteristics, clinical manifestations, diagnostic criteria, differential diagnosis process, and treatment strategies for prolactinomas, and proposes individualized management suggestions for special populations (such as pregnant women, male patients, and refractory cases). Treatment decisions strongly advocate for comprehensive evaluation by a multidisciplinary team of experts, including neurosurgery, endocrinology, radiology, radiation oncology, pathology, ophthalmology, and obstetrics/gynecology. Through the formulation of recommendation questions, evidence summary and evaluation, formation of recommendation opinions, expert discussions, and integration with clinical practice, 36 recommendations have been developed covering aspects such as screening, assessment, diagnosis, treatment, and monitoring. This consensus balances clinical needs with international evidence-based standards, provides a highly reliable reference for diagnosis and treatment, and is expected to enhance the standardization and overall level of prolactinoma diagnosis and treatment in China.

Background Chronic traumatic encephalopathy (CTE) is classically defined as a neuroglial tauopathy characterized by perivascular accumulation of hyperphosphorylated tau within neurons and astrocytes. Defining lesions localize to the depths of cortical sulci, implicating vascular and glial elements in early pathogenesis. This systematic scoping review evaluates the extent to which astrocytic dysfunction contributes to CTE pathogenesis, specifically whether astrocytic alterations precede or potentiate neuronal tauopathy. Methods A structured search of PubMed, Embase, Web of Science, and Scopus was conducted from inception through December 2025 in accordance with PRISMA 2020 guidelines. Due to substantial heterogeneity in study design, including postmortem analyses, experimental models, and biomarker studies, a qualitative synthesis was performed. Results Forty studies met inclusion criteria, converging on four domains: (1) interface-specific astrogliosis at perivascular sulcal depths; (2) disruption of aquaporin-4 polarization with uncertain translational relevance in humans; (3) astrocytic degeneration and impaired glutamate homeostasis; and (4) sustained neuroinflammation mediated through astrocyte-microglia signaling. Circulating GFAP emerged as a sensitive but non-specific biomarker of neuroglial injury. Conclusion CTE is best conceptualized as a neuroglial tauopathy in which astrocytes function as integral contributors to disease progression, likely in coordination with microglia. While astrocytic dysfunction may play an early role, its mechanistic specificity relative to other tauopathies remains incompletely defined.

Background Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is frequently refractory to medical and procedural therapy, particularly in the absence of neurovascular compression. Surgical options are limited when microvascular decompression is not appropriate. We report a salvage surgical approach combining internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory MS-related trigeminal neuralgia. Case presentation A 50-year-old woman with relapsing-remitting multiple sclerosis presented with medically refractory right-sided trigeminal neuralgia predominantly involving the V2/V3 distributions. She had previously failed optimisation of pharmacotherapy, two percutaneous retrogasserian glycerol rhizotomies, and Gamma Knife radiosurgery performed within the preceding year. Posterior fossa exploration via a retrosigmoid approach demonstrated no neurovascular conflict. Internal neurolysis (nerve combing) was therefore performed and supplemented with targeted glycerol delivery to the proximal cisternal segment of the trigeminal root adjacent to the radiologically relevant demyelinating lesion. Postoperatively, the patient experienced immediate improvement in facial pain with preservation of trigeminal sensation and no new neurological deficits. Her early postoperative course was complicated by a wound infection requiring surgical washout and antibiotic therapy. At 43-month follow-up, she remained free of ipsilateral trigeminal neuralgia with substantially reduced medication requirements. She later developed contralateral facial pain controlled with low-dose carbamazepine without recurrence on the operated side. Conclusion This report describes, to our knowledge, the first published case of combined internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory multiple sclerosis-related trigeminal neuralgia. In this highly selected case, durable ipsilateral pain control was observed. However, causal interpretation is limited by the single-case design, the combined nature of the intervention, and the potential delayed effects of prior radiosurgery. This approach should therefore be regarded as hypothesis-generating rather than practice-defining, but may merit further study as a salvage strategy in selected patients without neurovascular compression after failure of medical, percutaneous, and radiosurgical treatments.