2026年 · 第12卷第03期

Background Stereo-electroencephalography guided radiofrequency thermocoagulation (RF-TC) aims at changing epileptogenic networks to achieve therapeutic purpose. However, the functional connectivity mechanism of RF-TC remains unknown. We sought to determine the effects of RF-TC on functional connectivity and the relationship between these variations and the clinical outcome. Methods For this retrospective cohort study, we analyzed resting-state stereoelectroencephalography (SEEG) data segments to assess functional connectivity across sampling areas in seventeen epilepsy patients. We analyzed the variance of functional connectivity and graph theory indicators and assessed the relationship between variation and clinical response to RF-TC. Results We found decreased functional connectivity both within and between epileptogenic zone in alpha band (p < 0.05) after RF-TC. We also discovered the alteration of most graph theory properties in the alpha band. Moreover, within connectivity and betweenness were significantly decreased in alpha band in the non-improvement group (p < 0.05), while clustering coefficient showed opposite change in the improvement group (p < 0.05). Eventually, compared to improvement group, we discovered a greater decrease of within connectivity of alpha band in the epileptogenic zone (p < 0.01). Conclusion The research on network changes after radiofrequency thermocoagulation (RF-TC) is still an evolving field. Our research results indicate that significant changes occurred in functional connectivity and network characteristics in specific frequency bands and brain regions after RF-TC. Notably, the reduction in the internal connectivity within the alpha frequency band of the epileptic lesion not only provides early electrophysiological feedback for RF-TC, but also serves as a potential indicator for evaluating clinical response and prognosis.

Background Treating wide-necked aneurysms endovascularly is still difficult. Because of its high metal coverage and flow-diverting capabilities, the LVIS stent may lead to better results. We carried out this retrospective analysis to assess its hemodynamic impact, short-term efficacy, and procedural safety. Methods An observational, exploratory retrospective study was conducted between January and December 2023 on 61 consecutive patients with intracranial wide-necked aneurysms receiving LVIS stent-assisted coiling. The group consisted of 35 patients with ruptured aneurysms and 26 people with unruptured aneurysms. The Raymond-Roy Occlusion Classification (RROC) was used to assess the initial angiographic data. At 3 to 6 months, clinical outcomes were evaluated using the modified Rankin Scale (mRS), and parent artery patency and aneurysm recurrence were evaluated using follow-up digital subtraction angiography (DSA). Furthermore, a subset of patients underwent computational fluid dynamics (CFD) analysis to measure changes in intra-aneurysmal mean flow velocity and wall shear stress (WSS) in order to quantify hemodynamic modifications. Results This study included 35 patients with ruptured and 26 with unruptured aneurysms, with 61 patients totally. Immediate complete occlusion (RROC class I) was achieved in 80.0% (28/35) of ruptured and 84.6% (22/26) of unruptured aneurysms. Angiographic follow-up (available for 27 patients, 44.3%) at 6-12 months demonstrated stable occlusion in all initial RROC-I cases. Furthermore, in the ruptured cohort, the rate of favorable outcome (mRS 0-1) increased from 57.1% at discharge to 77.1% at follow-up, while 96.2% of unruptured patients maintained an mRS of 0-1. Procedure-related complications involved intraprocedural thrombosis (2 ruptured cases) and one fatal in-hospital stent thrombosis (unruptured case), resulting in overall morbidity and mortality rates of 16.4% and 1.6%, respectively. CFD analysis demonstrated significant and durable hemodynamic improvements. Specifically, post-operative reductions in relative inflow, aneurysm volume with high flow, and WSS were all sustained at 6-month follow-up (all P < 0.001). Conclusions Our study provides preliminary evidence that LVIS stent-assisted coiling may be related to high aneurysm occlusion rate, functional recovery in ruptured cases, and favorable hemodynamic modification. However, this study fails to achieve causal inference due to the retrospective design, and the complication profile underscores procedural risks, highlighting the need for prospective, comparative studies to confirm its safety and efficacy profile.

Background and objectives Duraplasty is commonly required when primary dural closure is not feasible during cranial surgery. Although both autologous and synthetic dural substitutes are widely used, high-quality prospective data comparing their early postoperative safety remain limited. This study aimed to compare early postoperative complication rates following cranial duraplasty using autologous pericranium versus high-density polypropylene (G-Patch). Methods This prospective randomized comparative study enrolled 121 consecutive patients undergoing cranial duraplasty at a tertiary care center between January and December 2021. Following exclusion of patients who died within 30 days postoperatively, 100 patients (50 per group) were included in the final analysis. Patients were allocated to receive either autologous pericranium (n = 50) or high-density polypropylene (G-Patch) (n = 50) using a standardized surgical technique. The primary outcome was the occurrence of any postoperative complication within 30 days, including cerebrospinal fluid leak, wound infection, and subdural empyema. Effect estimates were expressed as odds ratios (OR) with 95% confidence intervals (CI), and a limited adjusted analysis was performed as a sensitivity assessment. Results Traumatic brain injury and intracranial space-occupying lesions were the most common indications for surgery. Most patients in both groups had an uneventful postoperative course. Early postoperative complications occurred in 26% of patients in the synthetic graft group and 12% in the autologous group. The unadjusted odds ratio for any complication with synthetic graft use was 2.58 (95% CI: 0.88-7.54; p = 0.08). After adjustment for primary diagnosis, graft type remained a non-significant predictor of complications. No consistent associations were observed between postoperative complications and comorbidities or substance use in exploratory analyses. Conclusion In this prospective randomized cohort, both autologous pericranium and high-density polypropylene demonstrated acceptable short-term safety profiles. However, given the limited sample size, imbalance in underlying diagnoses, and short follow-up, these findings should be interpreted with caution and should not be considered evidence of equivalence between graft materials. Further studies with larger sample sizes, stratified analyses, and long-term outcomes are required.

Glioblastoma (GBM) poses a tremendous challenge because it causes substantial morbidity and mortality. Treatment remains constrained by the tightly regulated blood-brain barrier (BBB) and the heterogeneous blood-brain tumor barrier (BBTB), which together severely limit drug delivery to tumor tissue. Nanomaterial-based drug delivery systems offer an opportunity to overcome the short half-life, low bioavailability, and poor BBB penetration that restrict conventional GBM therapeutics. Nanotechnology also provides safe, effective, and targeted drug delivery systems that enhance penetration, stability, and therapeutic efficacy. This review discusses biomaterials-based nanomedicine platforms for GBM, with a focus on lipid-based carriers, polymeric nanoparticles, dendrimers, inorganic nanomaterials, and biomimetic nanosystems designed to interact with the BBB/BBTB. We summarize how passive and active brain-targeting strategies are combined with endogenous and exogenous stimuli-responsive designs (pH/redox sensitivity, magnetic hyperthermia, photothermal/photodynamic therapy, and ultrasound-triggered systems) to enhance intratumoral accumulation and anti-GBM efficacy. Overall, this review discusses recent advances in BBB-aware, stimuli-responsive, and biomimetic nanomedicines for GBM, and outlines their therapeutic potential alongside persistent challenges in safety, large-scale manufacturing, and clinical translation.

Prolonged disorders of consciousness (pDOC)—including coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS)—remain diagnostically and therapeutically challenging. Even with validated instruments such as the Coma Recovery Scale-Revised (CRS-R), behavioral assessment yields misdiagnosis rates approaching 40%, as fluctuating arousal, motor impairment, and sedation can mask preserved cognition. Because the VS/UWS-MCS distinction directly shapes prognostic counseling, rehabilitation, and decisions about life-sustaining treatment, and because the circuit-level pathophysiology of pDOC is still incompletely mapped, objective physiology-based biomarkers are urgently needed to complement bedside examination. This narrative review, informed by a structured search of PubMed, Embase, MEDLINE, and Web of Science, focuses on studies directly reporting intracranial electrophysiology—particularly local field potential (LFP) recordings from the central thalamus—in patients with pDOC. Indirect evidence from anesthesia paradigms, animal models, and related neuromodulation settings is invoked only to clarify mechanism or methodology. We group current findings into four complementary signal domains: oscillatory activity (slow oscillations and burst suppression through theta, alpha, beta, and gamma rhythms); thalamocortical and corticostriatal functional connectivity; aperiodic/scale-free dynamics reflecting excitation-inhibition balance; and nonlinear complexity measures indexing information integration. Single-unit firing, cross-frequency coupling (CFC), and evoked or perturbational responses are considered alongside these. All four are interpreted within a unifying mesocircuit-and-criticality framework, in which impaired consciousness reflects reduced arousal gain, degraded thalamocortical integration, and departure from the critical dynamical regime sustaining conscious-capable dynamics. Intracranial LFP recordings thus offer a rare mechanistic window onto thalamocortical dysfunction in pDOC and may eventually inform patient stratification, target selection, and mechanism-guided neuromodulation. The evidence base remains limited; however, small samples, etiological heterogeneity, variable recording conditions, sparse direct human data, and a predominance of group- rather than individual-level analyses constrain current inference. Translation is further complicated by unresolved ethical issues around surrogate consent, equitable access, and disclosure of diagnostic uncertainty. Meaningful progress will depend less on technical novelty than on standardized protocols, multicenter validation, and rigorous ethical frameworks.

Glioma is the most common primary malignant brain tumor in adults, among which glioblastoma (GBM) shows the highest degree of malignancy and the worst prognosis. Although standard therapeutic approaches, including surgical resection, radiotherapy, and chemotherapy, are routinely applied, the prognosis of glioma, especially GBM, remains poor. Metabolic rewiring is widely recognized as a major characteristic of malignant tumors and is especially evident in glioma. Recent studies have shown that fatty acid metabolic rewiring is a widespread feature of glioma and plays an important role in its pathogenesis and therapeutic resistance. Therefore, targeting metabolic reprogramming, particularly aberrant fatty acid metabolism, may have potential therapeutic implications in glioma. This review systematically synthesizes the molecular mechanisms underlying abnormal fatty acid metabolism in glioma pathogenesis and treatment responses. It also elucidates the regulatory networks governing key fatty acid metabolic pathways and integrates emerging strategies targeting these pathways to enhance the therapeutic sensitivity of glioma cells. Ultimately, this review aims to provide a conceptual framework and future research directions for overcoming the current limitations of glioma treatment through metabolic therapy.

Background Vestibular schwannomas (VS) are benign tumors affecting the vestibulocochlear nerve. They cause symptoms like hearing loss and vertigo. Treatment options include surgery and stereotactic radiosurgery (SRS). However, SRS can lead to rare complications like intratumoral hemorrhage (ITH). This review aims to explore ITH post-SRS, including its incidence and risk factors, to improve patient care. Methods This systematic review, conducted in accordance with PRISMA 2020 guidelines, examines intratumoral hemorrhage (ITH) post-radiosurgery for vestibular schwannomas. Searches encompassed PubMed, Google Scholar, the Cochrane Library, Embase, Web of Science, and Scopus up to January 2024. Inclusion criteria required documented vestibular schwannoma with confirmed ITH occurring after SRS. Data extraction involved study and participant characteristics, with discrepancies resolved by discussion. Given clinical and methodological heterogeneity, quantitative pooling was not performed; results are presented as a qualitative narrative synthesis. Results Eleven studies comprising 47 patients met inclusion criteria. Patients ranged from 25 to 79 years of age, with clustering in the sixth decade. A subset of patients had identifiable bleeding risk factors, most commonly hypertension and anticoagulant use. Symptom profiles were heterogeneous; trigeminal neuropathy and disequilibrium were the most frequently reported presentations. Management ranged from observation to surgical resection. On descriptive analysis, approximately half of patients demonstrated outcomes classified as favorable by the reporting authors; mortality was reported in 2 of 47 patients (4.35%). These figures must be interpreted with caution given the small total sample, predominance of case reports, and absence of standardized outcome definitions across included studies. Conclusion In conclusion, managing intratumoral hemorrhage following radiosurgery for vestibular schwannomas remains a complex clinical challenge. This review highlights varied patient outcomes, emphasizing the importance of personalized treatment approaches. Tailoring treatment decisions to individual factors such as tumor characteristics and patient preferences is crucial for optimizing outcomes and minimizing complications, underscoring the need for close collaboration among specialists in clinical practice.

Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Agitation is a common complication after moderate to severe TBI and managing it in the acute hospital setting can be challenging. Aim Currently, there are no standardised interventions to manage agitation in TBI. This review aims to evaluate contemporary research over the past 10 years which addresses pharmacological and non-pharmacological strategies for managing agitation post-TBI. Method A scoping review literature search was conducted using PRISMA guidelines. The protocol was pre-registered on PROSPERO (ID 1295903). The literature search used Mesh and Boolean keywords 'traumatic brain injury and 'agitation management’ in PubMed, and a free-text search of 'traumatic brain injury and agitation management’ with 'map term to subject heading’ in Embase (Ovid) and Cochrane, covering studies from 01 January 2015 to 09 March 2026. Findings were analysed and discussed between two reviewers. Results A total of 65 studies were identified, and after careful review, 13 papers were selected from PubMed and Embase for our Scoping Review. Non-pharmacological strategies highlighted the importance of orienting the patient and the supportive role of family during the acute recovery period. Pharmacological strategies included found that the antipsychotic olanzapine was helpful in managing agitation in moderate to severe TBI. Valproic acid in a small male sample [1] and a separate study using dextromethorphan and quinidine [2] found that these medications were also helpful in managing agitation in TBI. Discussion and conclusion Clinicians and health professionals reported that treating the patient holistically, with the medical, social, and psychiatric history was of benefit. Antipsychotic Olanzapine and Valproic acid may have their uses in the short-term, interim acute setting under supervision. Future research with larger sample sizes further investigating these medications would be useful, along with personalisation of medications to the patient’s medical history. Most of the studies included in the review are observational and reviews, rather than randomised controlled trials, with a lack of primary evidence which may be a limitation.

Background Hutchinson-Gilford progeria syndrome (HGPS) is an exceedingly rare genetic disorder characterized by accelerated aging and profound vascular fragility. While cerebrovascular accidents are common in this population, traumatic epidural hematomas (EDH) are clinical rarities, with only two pediatric cases previously documented. Currently, it is estimated that fewer than 200 children with HGPS are living worldwide. The primary objective of this report is to present a comprehensive multidisciplinary management strategy for traumatic EDH in a 15-year-old HGPS patient, highlighting the critical interplay between progerin-induced vascular stiffening, reduced intracranial compliance, and the formidable anesthetic challenges encountered in the oldest reported survivor of this pathology. Case presentation A 15-year-old female with HGPS presented with a right frontoparietal EDH following a ground-level fall. Initial Glasgow Coma Scale (GCS) was 14 but declined to 12 within 4 h. Cranial computed tomography (CT) revealed a large EDH measuring 22 mm at maximum thickness, causing a 6 mm midline shift. Due to severe glottic sclerosis and anatomical distortion, multiple orotracheal and fiberoptic (2.8 mm) intubation attempts failed. An emergency percutaneous tracheostomy was performed to secure the airway. Intraoperative findings revealed active bleeding from a coronal suture diastasis, which was managed with bone wax and dural tenting sutures. The patient achieved full neurological recovery and was discharged on postoperative day 10. Conclusion Managing HGPS patients requires a high index of clinical suspicion for intracranial injury even after minor trauma, as progerin-induced vasculopathy accelerates hematoma expansion. Standard airway techniques can fail due to progressive laryngeal changes, necessitating early consideration of surgical airways. Prompt multidisciplinary intervention and meticulous neurosurgical technique are essential to mitigate risks associated with extreme vascular fragility and complex anatomy in this high-risk population.

Background Multifocal, deep-seated brain abscesses are uncommon and often lead to rapid neurological decline because of mass effects, widespread edema, and the challenge of safely accessing multiple intracranial compartments. Traditional surgical approaches may require staged operations or extensive craniotomy, increasing procedural risk. Robot-assisted stereotactic aspiration offers a minimally invasive and highly precise alternative, yet its application in single-session, multitarget drainage remains rarely reported. This case describes a young patient with extensive bilateral brain abscesses that were successfully treated through one-stage, robot-guided multisite aspiration, highlighting the potential advantages of this technique in complex infectious neurosurgical emergencies. Case presentation A 21-year-old woman presented with rapid onset of confusion, headache, and progressive neurological deficits. Magnetic resonance imaging revealed multiple deep abscesses involving the frontal, temporal, and occipital lobes, accompanied by severe cerebral edema and midline shift. After multidisciplinary evaluation, a single session of stereotactic aspiration was performed using a robot-assisted navigation system. Six abscess cavities were drained through four precisely planned trajectories during a single operation. Broad-spectrum antimicrobial therapy was initiated empirically and later tailored according to microbiological findings. A short-course of low-dose dexamethasone was added to reduce cerebral edema while minimizing the risk of impaired infection control. The patient demonstrated marked neurological improvement within several days and achieved full functional recovery within 1 month. Conclusions This case illustrates that robot-assisted, minimally invasive stereotactic aspiration may represent a potentially safe and effective strategy for managing multifocal deep brain abscesses in selected patients, allowing accurate multitarget drainage in a single procedure. The rapid recovery observed in this patient supports the clinical value of integrating precise surgical intervention with optimized antimicrobial therapy and controlled edema management. This approach may offer a viable treatment pathway for similarly complex intracranial infections where conventional surgery is associated with significant risk.