Volume 37 · Issue 06 · 2021

To preliminarily explore the safety and efficacy of endovascular therapy for traumatic vertebral artery dissecting aneurysms (TVADA).

A total of 14 patients with TVADA underwent endovascular therapy at Department of Neurosurgery, The First Affiliated Hospital of Naval Medical University from January 2017 to December 2019 and were consecutively enrolled into this retrospective study. Among them, 11 cases were treated with stent-assisted coiling, 2 cases with stent only, and 1 case with flow diverter device. Surgical complications and outcomes were documented.

Successful operations were performed in all 14 cases. Immediate postoperative angiograph revealed partial visualization of the aneurysm in 11 cases and complete occlusion of aneurysm in 3. Post operation, there were 1 patient who died of intracranial hemorrhage and 1 patient developing muscle strength decrease which resolved following treatment. Twelve patients were followed up for an average of 29.5±10.8 months (12-47 months), including 11 patients with Glasgow outcome scale grade Ⅴ and 1 patient with GOS grade Ⅳ. Ten patients underwent imaging follow-up lasting for an average of 24.6±10.4 months (6-40 months), and all reported complete occlusion of dissection aneurysms.

Our preliminary observation has suggested that endovascular therapy is safe and effective for TVADA, which could lower the long-term risk of the patient′s re-bleeding.

To explore the safety and efficacy of drug-coated balloon (DCB) angioplasty in the treatment of symptomatic intracranial atherosclerotic stenosis (ICAS).

A retrospective analysis was conducted on the clinical data of 48 patients with symptomatic ICAS admitted to Department of Neurosurgery of Beijing Hospital from September 2018 to May 2020. All patients underwent percutaneous transluminal angioplasty (PTA) with DCB. The postoperative restenosis was evaluated by imaging follow-up, and the degree of arterial stenosis >50% was defined as restenosis. Clinical follow-up was conducted to observe whether the patient had recurrence of ischemic events in the area related to the corresponding artery. All patients were divided into anterior circulation group (30 cases) and posterior circulation group (18 cases) according to the location of arterial stenosis. The differences in general information, perioperative complications, stroke incidence and restenosis rate during follow-up were compared between the two groups.

A total of 51 lesions of intracranial artery stenosis in 48 patients were treated with DCB. The in-place success rate of DCB was 98.0% (50/51). The median postoperative residual stenosis rate (interquartile range) was 22.5% (25.0%), which was significantly different from the preoperative stenosis rate (interquartile range)[80.0% (20.0%)](Z=-8.745, P<0.001). There were 2 cases of stroke (4.2%) during the perioperative period, and no patients died. Forty-six patients underwent imaging follow-up for 5.5 (5.0) months, the incidence of arterial restenosis was 4.3% (2/46), and the incidence of symptomatic restenosis was 2.2% (1/46). All 48 patients underwent clinical follow-up which lasted for 8.0 (6.0) months, and 2 cases (4.2%) developed ischemic complications, including 1 case of stroke caused by the corresponding artery and 1 case of transient ischemic attack. The anterior and posterior circulation groups had no statistically significant differences in perioperative complications, stroke incidence or restenosis rate during follow-up (allP>0.05).

For patients with symptomatic ICAS, no matter whether the lesion is located in the anterior or posterior circulation, the use of DCB for angioplasty is relatively safe, and the short-term effect seems satisfactory.

To investigate the predictive values of island signs and black hole signs on non-contrast enhanced CT in early hematoma enlargement of patients with primary intracerebral hemorrhage (pICH).

A total of 85 patients with pICH were admitted to Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from February 2018 to August 2020, and their clinical and imaging data were retrospectively studied. For all patients, the initial CT was performed within 6 h following the onset, and the second CT examination was conducted within 24 h after the initial CT. The patients were divided into the early hematoma enlargement group and hematoma non-enlargement group according to whether there was enlargement of early hematoma (increase of hematoma volume >6 ml or >33%). The clinical data of the two groups were compared, and all factors in the univariate analysis with P<0.10 were included in the multivariate logistic regression analysis to explore the independent factors predicting early hematoma enlargement. The receiver operating characteristic curve was drawn, the area under the curve (AUC) was calculated and the predictive values of CT signs in early hematoma enlargement were analyzed by using CT reexamination results as gold standard.

The first CT examination showed that there were 24 cases with island sign and 27 cases with black hole sign. All patients were divided into the early hematoma enlargement group (28 cases) and hematoma non-enlargement group (57 cases). There was no significant difference between the 2 groups in the patient′s gender, age, Glasgow coma scale (GCS) score at admission, site of hemorrhage, systolic and diastolic blood pressures on admission, or the time interval from onset to the first CT examination (all P>0.05). Compared with the hematoma non-enlargement group, the hematoma enlargement group had larger hematoma volume on the first CT images, higher proportion of patients with island sign and higher proportion of patients with black hole sign (allP<0.05). Multivariate logistic regression analysis showed that both island sign (OR=10.319, 95%CI: 3.011-35.372, P=0.001) and black hole sign (OR=4.181, 95%CI: 1.327-13.170, P=0.015) were independent risk factors for early hematoma enlargement. For island sign, black hole sign and island sign combined with black hole sign, their sensitivities for predicting early hematoma enlargement were 60.7%, 57.1% and 82.1% respectively, their specificities were 87.7%, 80.7% and 73.7% respectively, and their AUC values were 0.742, 0.689 and 0.779 respectively.

Both island sign and black hole sign seem valuable in assistance of clinical prediction of early hematoma enlargement in primary intracerebral hemorrhage. The combination of island sign and black hole sign has better predictive ability than either single indicator.

To explore the surgical strategies of clipping of basilar artery bifurcation aneurysms through various approaches.

We retrospectively reviewed the clinical data of 19 patients with basilar artery bifurcation aneurysms who underwent microsurgical clipping at Department of Neurosurgery, Taihe Hospital of Shiyan City from June 2014 to April 2019. Of all 19 cases, 15 were ruptured aneurysms and 4 were unruptured. Various surgical approaches were used according to the shape of aneurysm and its relationship with posterior clinoid process. In this series, 10 cases underwent transorbitozygomatic approach, 5 cases underwent pterional approach, and 4 cases underwent infraorbital approach. The intraoperative indocyanine green (ICG) angiography was performed to confirm the efficacy, and imaging outcome was evaluated by CTA on the 2nd day post operation. Clinical and imaging follow-up was conducted at 6 months post operation. The modified Rankin scale (mRS) was used to assess the outcomes.

Of all 19 aneurysms, 17 cases were completely clipped and 2 case was wrapped and reinforced. Post operation, there were 6 cases of oculomotor nerve palsy, 2 cases of cerebellar infarction resulting in vertigo and cerebellar ataxia, 1 cases of hemiplegia and 1 case of coma. Three patients with ruptured aneurysms developed hydrocephalus at 2 months after operation and underwent ventriculoperitoneal shunting. No death was reported during perioperative period.All 19 patients were followed up for a period of 20.0±8.1 months (6 to 50 months). One patient died of pulmonary infection at 37 days post operation. The mRS scores of 18 patients were 0-1 in 10 cases, 2 in 3 cases, 3 in 3 cases, 4 in 2 cases and 6 in 1 case at 6 months post operation.

Craniotomy for aneurysm clipping is the main treatment option for basilar artery bifurcation aneurysms. According to the morphological characteristics of aneurysms, different surgical approaches are selected and relatively good clinical outcomes could be achieved.

To evaluate the efficacy and safety of middle meningeal artery (MMA) embolization for chronic subdural hematoma (CSDH).

A retrospective study was conducted on the clinical data of 11 patients (16 sides) with CSDH who underwent MMA embolization at Department of Neurosurgery, Affiliated Hospital of Nantong University from April to November of 2020. Among them, 5 cases with 7 sides of CSDHs were embolized by Polyvinyl alcohol (PVA) and 6 cases with 9 sides of CSDHs by Onyx-18. The clinical follow-up was evaluated by modified Rankin scale score (mRS), and the decrease of mRS ≥1 was regarded as improvement. The absorption of hematoma was assessed by imaging.

The MMA of 11 patients (16 sides of hematomas) was successfully over-selected, and the frontoparietal branch of MMA and its branches were completely occluded. No surgery-related complications occurred. The follow-up time of 11 patients was 30-120 (70.0±29.5) days. The clinical symptoms of all patients were improved (decrease of mRS by 1 to 2 points). Imaging follow-up showed that 4 sides of hematomas were completely absorbed, the absorption rate was ≥90% for 5 sides of hematomas, ≥80% for 2 sides, and 30%-50% for 5 sides. Among the 8 patients (12 sides of hematomas) followed up for 60 to 120 days, the hematoma absorption rate for 1 side was 50%, and the rest was 80% to 100%. In the 3 patients (4 sides) followed up for 30 days, the hematoma absorption rate was 30%-40%. There was no recurrence during the follow-up period.

Preliminary observations show that MMA embolization for CSDH is safe and effective, which is gradually absorbed over time and the recurrence of hematoma could be prevented.

To evaluate the clinical efficacy of the combination of endovascular treatment and microsurgery in the treatment of intracranial arteriovenous malformations (AVM).

A retrospective analysis was conducted on the clinical data of 32 cases of intracranial AVMs undergoing combined surgery at Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School form August 2018 to November 2020. In this series, 9 cases underwent simultaneous combined surgery and the other 23 cases underwent staged combined surgery.

In all 32 cases, the malformed vascular mass was completely removed, and the intraoperative blood loss was 378.1±179.1 ml (100-900 ml). Surgery-related complications included 6 cases of limb hemiplegia, 2 cases of visual field defect, 1 case of operative field bleeding, 1 case of hydrocephalus, and 8 cases of intracranial infection, all of which were controlled after active treatment. The postoperative follow-up lasted for 3 to 6 months. The modified Rankin Scale scored 26 cases with grade 0, 3 cases with grade 1, 2 cases with grade 2, and 1 case with grade 3. The rate of favored outcome (grade 0 to 1) was 90.6% (29/32). There was no recurrence of AVM during the imaging follow-up.

Endovascular therapy combined with microsurgery for the treatment of intracranial AVM can help increase the total resection rate of AVMs, reduce intraoperative bleeding, and reduce surgery-Srelated complications.

To discuss the clinical characteristics, treatment and prognosis of bilateral thalamic gliomas.

A retrospective analysis was conducted on the clinical data of 18 patients who were diagnosed with bilateral thalamic gliomas based on stereotactic biopsy from January 2015 to December 2019 at Department of Neurosurgery, the Sixth Medical Center of PLA General Hospital. The patient′s subsequent therapy, survival status and overall survival were followed up through outpatient reexamination and telephone inquiry.

The median age of the 18 patients (15 adults and 3 children) was 35.5 years (range: 3 years and 4 months to 68 years), and the male/female ratio was 1.25 ∶1.00. The initial symptoms were intracranial hypertension in 4 cases, somnolence in 3 cases, diplopia in 3 cases, epileptic seizure in 3 cases, blepharoptosis in 2 cases, hearing impairment in 1 case, limb weakness in 1 case, and salivation in 1 case. Pathological diagnoses were established in all 18 cases including IDH (isocitrate dehydrogenase) wild type diffuse astrocytoma in 10 cases, IDH wild type anaplastic astrocytoma in 2 cases, and H3 K27M mutant diffuse midline glioma in 6 cases. Epidermal growth factor receptor was positive in 13 patients, and the Ki-67 index ranged from 3% to 20%. None of patients had IDH1 mutation or X-linked alpha-thalassemia/mental retardation (ATRX) mutation. The median postoperative follow-up period for the 18 patients was 10 months (range: 6 weeks to 21 months). Among those 18 patients, radiotherapy was performed in 1 case, temozolomide chemotherapy in 2 cases, and chemoradiotherapy in 15 cases following biopsy-based diagnosis. Nine patients developed secondary hydrocephalus and 5 out of them underwent ventriculoperitoneal shunting. At the latest follow-up, there were 16 deaths and 2 survivors. The median survival period of 16 patients was 13 months (range: 6 weeks to 21 months).

Bilateral thalamic gliomas, commonly seen in adults, are often associated with atypical clinical symptoms and secondary hydrocephalus. Comprehensive treatments such as chemoradiotherapy and ventriculoperitoneal shunting can be administered, but the outcomes generally seem unfavorable.

Obtaining the lesion-vein relationship preoperatively by imaging methods is crucial for intraoperative decision-making. In this study, the clinical data of patients with meningioma (29 cases) and glioma (11 cases) in the central region treated by neurosurgery in Heze Municipal Hospital from September 2017 to April 2020 were retrospectively analyzed, and the three-dimensional anatomical structures of lesions, veins and arteries were fused by multimodal imaging three-dimensional reconstruction technology to form a visual model, so as to explore the consistency between the preoperative reconstructed images and the morphological structure, course of veins and their relationship with the location of lesions seen during operation. The results showed that the two showed good agreement in showing the relationship between superficial vein in central region and tumor in central region; Three-dimensional reconstruction of multimodal imaging has certain application value in the localization of tumor and vein in central region.

To investigate the effects of different oxygen concentrations on the proliferation and differentiation of hair follicle neural crest stem cells(hfNCSC)and then to determine a suitable oxygen condition for hfNCSC to proliferate and maintain an undifferentiated state.

The tissues in the bugle area of the hair follicles of Sprague Dawley rats were isolated by microdissection and cultured at three different oxygen concentrations: 1% (hypoxia group), 3% (intermediate hypoxia group), and 20% (normal oxygen group). On the 10th and 13th days, CCK-8 was used to detect the proliferation activity of the three groups of hfNCSC. On the 13th day of the culture, immunofluorescence was used to detect the expression of neural stem cell marker-Nestin, neural crest stem cell marker-Sox10, and neuron marker-β-Ⅲ Tubulin. On the 13th day of culture, the expressions of HIF-2α, Oct4, Nanog, Lin28, Sox2, KLF4, Nestin, Sox10, Slug, and PAX3 in hfNCSC were detected by real-time quantitative PCR. On the 13th day of culture, the expression of Oct4 and Sox2 was detected by Western blot.

(1) CCK-8 results showed that on the 10th day, the hfNCSC had the highest proliferation activity in the intermediate hypoxia group (absorbance ratio: 1.868±0.147), which was significantly different from that in the hypoxia group(1.580±0.147) and the normoxia group(1.451±0.037) (both P<0.01). On the 13th day, the proliferative activity of hfNCSC in the intermediate hypoxia group was the highest (absorbance ratio: 5.322±1.111), which was not significantly different from that of the hypoxia group (4.117±0.672,P=0.088), whereas the difference was statistically significant compared with the normoxia group (1.535±0.119, P<0.001). (2) Immunofluorescence results showed that Nestin, Sox10, and β-Ⅲ Tubulin were all expressed under three different oxygen concentrations. Nestin and β-Ⅲ Tubulin were localized in the cytoplasm, Sox10 was localized in the nucleus and cytoplasm. (3) Real-time quantitative PCR results showed that Oct4, Nanog, Lin28, HIF-2α, Sox10, Slug, PAX3 had the highest expression levels under 3% oxygen concentration (intermediate hypoxia group), which were different from those in the other two groups(allP<0.05). Nestin, Sox2, and KLF4 had the highest expression levels under 1% oxygen concentration, and their differences from those in the other two groups were statistically significant (allP<0.01). (4) Western blot results showed that the expression levels of Oct4 and Sox2 under 3% oxygen concentration were higher than those in the other two groups.

Hypoxia is beneficial for the proliferation of hfNCSC and maintenance of the undifferentiated state. The 3% oxygen concentration seems more suitable for the proliferation and undifferentiated state of hfNCSC.

To explore the expression characteristics of BPIFB1 in non-functional pituitary adenomas (NFPAs) and its effect on the ability of proliferation and invasiveness of pituitary adenomas.

The microarray data of pituitary adenoma from the public GEO (Gene Expression Omnibus) database and bioinformatic analysis were used to screen out the genes related to invasiveness of pituitary adenomas. The expression level of BPIFB1 was analyzed by RT-qPCR and IHC staining in the selected tissue specimens from 5 specimens of invasive tumors and 5 specimens of non-invasive tumors respectively. Small interfering RNAs (siRNA) were used to knockdown the expression of BPIFB1 in GH3 cells; the cell viability was tested by the CCK-8 experiment; the wound healing assay was used to analyze the migration ability of GH3 cells. RT-qPCR and Western blot analysis were used respectively to explore the mRNA expression levels of matrix metalloproteinases MMP-2 and MMP-9 and the expression of proteins associated with epithelial-mesenchymal transition (EMT).

Bioinformatics analysis showed that the expression of BPIFB1 decreased in invasive pituitary adenomas compared with non-invasive adenomas (log₂FC=-5.29, P<0.01). Immunohistochemical staining showed that the expression of BPIFB1 in invasive NFPAs (0.53±0.10,n=5) was significantly lower than that in non-invasive NFPAs (1.02±0.44, n=5; P<0.05). The expression of BPIFB1 mRNA was negatively correlated with Knosp grade of pituitary adenoma (r_s=-0.88, P<0.01). Cell viability assays showed that the cell viability of BPIFB1 knockdown GH3 cells (2.98±0.14) was higher than that of control GH3 cells (2.14±0.05;P<0.01). Cell scratch assays showed that the migration rate of BPIFB1 knockdown GH3 cells (43.82%±3.74%) was higher than that of control GH3 cells (17.53%±2.05%;P<0.01). The expression levels of MMP-2 and MMP-9 mRNA of BPIFB1knockdown GH3 cells were higher than those of control GH3 cells (bothP<0.05). The expression levels of EMT related proteins of BPIFB1 knockdown GH3 cells were different from those of control GH3 cells (allP<0.05). Further bioinformatics analysis showed that TGF-β, MAPK and other signaling pathways were correlated with invasiveness of pituitary tumors.

The expression of BPIFB1 seems to be decreased in invasive NFPAs, and BPIFB1 might inhibit the proliferation and invasion of pituitary tumor cells through regulating the expression of MMP family and EMT.

To investigate the synergistic regulation of hypoxia-inducible factor (HIF) 1α and 2α on proliferation and chemotherapy resistance of human glioma cells in vitro.

The primary tissues were collected from the tumor specimens obtained during operations at Department of Neurosurgery, the First Affiliated Hospital of Army Military Medical University. The expression of HIF1α and HIF2α in tumor tissues was detected by immunohistochemistry. The expression of HIF1α and HIF2α was detected by immunofluorescence and Western blotting after 72 h of hypoxia culture. CRISPR /Cas9 was used to knock out the expression of HIF1α and HIF2α in the cells, and the cells were divided into HIF1α and HIF2α knockout alone groups, HIF1α+ HIF2α knockout group and vector control group. After 72 h of hypoxic culture, cell proliferation was detected by CCK-8, and cell cycle was detected by flow cytometry. After 72 h of hypoxic culture with temozolomide, cell proliferation and apoptosis were assessed.

Immunohistochemical results showed that HIF1α and HIF2α were highly expressed in glioma tissues. After 72 h hypoxia culture, HIF1α and HIF2α were highly expressed which was indicated by immunofluorescence staining and Western blotting assay. CRISPR /Cas9 successfully knocked out the expression of HIF1α and HIF2α. After 72 h of hypoxia culture, CCK-8 showed that the proliferation rate of HIF1α+ HIF2α knockout group was higher than that of the vector control group, HIF1α knockout alone group or HIF2α knockout alone group (F=24.419, P<0.001). There was no significant difference between HIF1α or HIF2α knockout group and vector control group (P>0.05). Cell cycle analysis showed that the proportion of G₀/G₁ phase cells in HIF1α+ HIF2α knockout group was lower than that in the vector control group, HIF1α or HIF2α knockout group alone, and the proportion of G₂/M+ S phase cells was higher than that in the vector control group, HIF1α or HIF2α knockout group alone (F=5.326, P=0.025). There was no significant difference in cell cycle between HIF1α or HIF2α knockout group and vector control group (bothP>0.05). After adding temozolomide into the medium, the cell proliferation rate in HIF1α+ HIF2α knockout group was lower than that in vector control group, HIF1α or HIF2α knockout group (F=46.518, P<0.001), and the cell proliferation rate in HIF1α or HIF2α knockout alone group was lower than that in vector control group (bothP<0.05).

HIF1α and HIF2α play synergistic roles in regulating the proliferation and chemotherapy resistance of human glioma cells.

To investigate the working status of Chinese skull base neurosurgeons and to provide data support for disciplinary development.

A questionnaire survey of clinicians engaged in skull base surgery in 357 hospitals in 31 provinces, municipalities and autonomous regions across the country of China was conducted using WeChat from November 1, 2019 to December 10, 2019. A total of 557 people participated. We obtained their basic information, education and training, practice status, income and satisfaction, scientific research, hospital construction and other aspects of skull base surgery practitioners' data, and conducted cross-sectional analysis on the entire group.

Among practitioners of skull base surgery, male accounted for 99.1% (552/557); the age [median (quartiles)] was 42.2 years (36 and 48 years). Physicians with doctor′s degree accounted for 33.9% (189/557), and those with master′s degree accounted for 39.0% (217/557). Physicians with senior title accounted for 72.2% (402/557). Among all skull base surgeons in this series, 66.1% (368/557) were qualified to perform grade IV surgery, of whom 76.9% (283/368) had a postgraduate degree, 90.5% (333/368) had a senior professional title, and 91.3% were employed in a tertiary hospital ( 336/368), and 57.9% (213/368) were employed in provincial hospitals. A total of 98.6% (549/557) of skull base surgeons had participated in various advanced studies, academic conferences, and training courses; 66.2% (369/557) of skull base surgeons had the experience of presiding and participating in various research projects. In this investigation, 84.0% (468/557) of skull base surgery practitioners were not satisfied with their current salaries.

Chinese skull base surgeons are mainly working at large hospitals. They have relatively higher academic qualifications and professional titles, are more involved in complicated operations, and have greater pressure at work. They have more urgent needs for continuing education and scientific research, but are not satisfied with the current salaries.

To investigate the basic situations of allocation of neurosurgery medical resources in Hubei province so as to explore its distribution characteristics and existing problems.

Under the framework of Hubei Provincial Center for Medical Quality Management of Neurosurgery, the basic situations of neurosurgery practice at 241 health and medical institutions in Hubei province were investigated through questionnaires and interviews. The data of hospital construction, discipline construction, talent cultivation and other corresponding indicators were collected, sorted and cross-sectionally analyzed. The survey time period was from September 2019 to November 2019.

A total of 195 (80.91%) medical institutions in Hubei province have carried out neurosurgery practice, including 87 tertiary hospitals (44.62%) and 108 secondary hospitals (55.38%). There were 10 209 beds in total, including 8 710 ordinary beds (85.32%) and 1 499 intensive care unit (ICU) beds (14.68%), and there were 50 specialized ICUs. The number of neurosurgery specialty beds was the highest in Wuhan and reached 2 651 (25.97%). There were 1 697 neurosurgeons and 3 725 nurses in total, and there were 507 neurosurgeons (29.88%) and 1 126 specialty nurses (30.23%) in Wuhan. There was 1 national key discipline, 6 doctoral degree authorized disciplines, and 5 post-doctoral mobile stations in Hubei province. Doctoral degree authorized disciplines and post-doctoral mobile stations were mainly distributed in the affiliated hospitals of key universities and the military command general hospital, which were all located in Wuhan.

The overall medical resources of neurosurgery in Hubei province are generally rich, and the high-quality resources are mainly concentrated in Wuhan and some other big cities. The development of neurosurgery in individual cities lags behind.

To discuss the current psychological pressures of neurosurgery medical staff, and to provide data support for improving the mental health of neurosurgery medical staff.

This study was a cross-sectional study. From September 2019 to June 2020, we conducted a cluster-sampling questionnaire survey among staff at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University by using the Chinese perceived stress scale. Participants were divided into the low psychological stress group and the high psychological stress group according to the scale score. We explored the influencing factors of participants′ psychological stress by using univariate analysis and multivariate logistic regression analysis. Meanwhile, the source of stress and corresponding remedies were analyzed.

A total of 385 valid questionnaires were obtained, which were from 117 subjects in high stress group and 268 subjects in low stress group. The mean perceived stress scale score was 21.1±8.6 points. Univariate analysis showed that there were significant differences in the level of psychological stress among medical staff with different working years (length of employment) (U=3.465, P=0.001) and ages (U=2.007, P=0.045). There was no significant difference in the level of psychological stress among those with different genders, marital statuses, professional ranks, positions, academic degrees or professional titles (all P>0.05). Multivariate logistic regression analysis showed that lower professional titles and longer working years might be independent risk factors for high psychological stress state (bothP<0.05). Work stress (57.9%, 223/385) was the main source of psychological stress. There was significant difference in the sources and types of psychological stress between neurosurgeons and nurses (bothP<0.05). Attention diversion (64.7%, 249/385) was the most common way to relieve psychological stress for neurosurgery medical staff.

The working years and professional titles of neurosurgery medical personnel have some influence on the occurrence of high psychological stress state, and their psychological pressure mainly comes from work pressure.