Volume 37 · Issue 09 · 2021

To explore the application value of Neuro Omega intelligent analysis module (HaGuide) in deep brain stimulation (DBS) surgery.

A retrospective analysis was conducted on the clinical data of 75 patients with Parkinson′s disease (PD) treated with the subthalamic nucleus (STN)-DBS assisted with the Neuro Omega system HaGuide at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from September 2020 to November 2020. The length of STN nucleus and the length of STN sensorimotor subregions identified by HaGuide during the operation were documented. One month after the operation, the device of DBS was turned on and the matching degree between the effective contacts and those located in the sensorimotor area identified by HaGuide was judged. The third part of the Unified Parkinson′s Disease Rating Scale (UPDRSⅢ) was used to evaluate the improvement of the patient′s motor symptoms.

The operations of 75 patients were successful, including 73 cases of bilateral DBS and 2 cases of unilateral DBS, which involved a total of 148 sides (hemispheres). Among which 146 sides were included, and 2 sides were exduded. Among the 146 sides of operations, STN was identified on 109 (74.7%, 109/146) sides, and the length of STN was 5.6±1.1 mm(3.2-8.6 mm). Furthermore, the STN sensorimotor subregion could be identified on 88 (80.7%, 88/109) sides, and its length was 2.6±1.2 mm (0.3-6.3 mm). The signal on the other 37 (25.3%, 37/146) sides was not obvious, and the impedance of microelectrode on 12 sides was no more than 300 kΩ, while the intraoperative test results were satisfactory. The matching degree between the effective contacts determined at the device startup and the contacts located in the sensorimotor subregion identified by HaGuide was 79.6% (70/88). The med-off UPDRS-Ⅲ score of 75 patients was significantly lower than that before operation (25.9±10.3 pointsvs. 50.8±15.7 points, t=8.633, P<0.05), and the improvement rate was (46.5±19.5)%.

The preliminary study suggests that the application of HaGuide in DBS could identify the sensorimotor subregions of STN in most cases, and the accuracy for guiding electrode implantation seems relatively high, and the motor symptoms of PD patients are improved after the startup of device.

To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions.

A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2021. Before surgery, the patient’s skull MRI with enhancement, diffusion tensor imaging (DTI), and CT angiography (or magnetic resonance angiography) data were fused to reconstruct nerve tracts, tumors, blood vessels, skulls and other structures, so as to design the optimal surgical path, and used in neuronavigation to guide tumor resection. Degree of tumor resection was evaluated by using MRI results 72 hour post operation. One week, one month, and three months after surgery, the Boston Diagnostic Aphasia Examination (BDAE) was used to assess language function, and the simplified Fugl-Meyer Assessment (FMS) was used to assess motor function.

Through the three-dimensional image reconstruction, the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts, arteries and veins were clearly shown, the displacement and destruction of the nerve tracts were clarified, and the blood supply arteries and drainage veins were shown. Among the 30 patients, the tumor involved the motor area in 21 cases and language area in 25 cases. Totally resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). Among the 21 patients with preoperative neurological deficits, at the last follow-up, 20 patients had improved neurological function after surgery, and 1 patient had unchanged neurological function compared with presurgical conditions. Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery, which resolved after 1 week.

The use of multimodal images to three-dimensionally reconstruct tumors and surrounding nerve fiber bundles, blood vessels and other important structures, so as to design surgical approaches and apply them to intraoperative navigation to guide the operation, could help protect the eloquent brain area and improve the efficacy of surgery.

To investigate the accuracy and safety of 3D-intelligent structured light registration in robot-assisted neurosurgical operations.

A retrospective analysis was conducted on the data of 77 patients admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from August 2020 to January 2021. All patients underwent neurosurgical robot-assisted surgery based on 3D-intelligent structured light registration; 70 of them underwent stereotactic biopsy, 1 underwent cyst puncture and Ommaya reservoir placement, 1 underwent stereoelectroencephalography (SEEG) electrode placement, and 5 underwent navigation-assisted positioning of intracranial lesion. Through the fusion of postoperative head CT and preoperative surgical planning images, the registration error and the error of the skull entry point were analyzed to evaluate the accuracy of its positioning, and the difference between the registration based on CT and the registration based on MRI was compared. The occurrence of postoperative complications was documented.

All 77 patients completed the structured light registration within 2 minutes. The registration error of 27 patients based on CT was 0.18±0.03 mm (0.13-0.23 mm), and the registration error of 50 patients based on MRI was 0.38±0.09 mm (0.15-0.52 mm), the difference between the two was statistically significant (P<0.01). The error of the skull entry point based on MRI was 1.30±0.78 mm (0.19-3.28 mm), and the error of the skull entry point based on CT was 1.62±1.05 mm (0.29-3.27 mm), the difference between the two was not significance (P=0.29). Among them, the error of the six skull entry points in 1 case of SEEG operation was 0.98±0.51 mm (0.32-1.74 mm). There were no deaths after surgery, bleeding events related to surgery, intracranial infection or poor healing of surgical incisions, etc.

Preliminary research has indicated that the application of 3D-intelligent structured light registration and positioning technology to neurosurgical robotic surgery has the advantages of short registration time, small positioning error, and good safety. Compared with MRI-based registrants, CT-based registration errors are smaller, while their errors of skull entry points seem similar.

To explore the clinical application of robot-assisted intracranial lesion biopsy in elderly patients.

A retrospective analysis was conducted on the clinical data of 30 elderly patients (72-93 years old) who underwent robot-assisted intracranial lesion biopsy at the Department of Neurosurgery, Peking University Third Hospital from March 2019 to March 2021. Pathological examinations were performed after the operation, and the surgical accuracy of the robot was evaluated, including navigation accuracy errors and puncture accuracy errors. The multiple linear regression method was used to determine the clinical factors that affected the accuracy of puncture.

The puncture needles of 30 patients were all inserted into the target lesion at one time, and the needle tips were all located in the lesion tissue. After the operation, 1 patient developed bleeding in the target area (hematoma volume <10 ml); 1 patient developed epileptic seizure. All 30 patients received pathological examinations, which revealed neoplastic lesions in 24 cases, including lymphomas in 10 cases, metastatic carcinomas in 6 cases, neuroepithelial tumors in 5 cases and germ cell tumors in 3 cases. The other 6 patients had non-neoplastic lesions, including 4 cases of non-specific inflammation, 1 case of multiple sclerosis and 1 case of demyelinating disease. The robot navigation accuracy of 30 patients was 0.4±0.2 mm (0.1-0.7 mm), the puncture accuracy was 1.0±0.2 mm (0.6-1.3 mm), and the navigation accuracy was higher than the puncture accuracy ( t=-11.64, P<0.01). The results of multiple linear regression analysis showed that gender, age, and whether the lesion was tumor or not had no effect on the puncture accuracy (allP>0.05), and whether there was extensive brain atrophy was the clinical factor that affected the puncture accuracy (t=-2.52, P<0.05).

Robot-assisted biopsy for elderly patients with intracranial lesions has few postoperative complications and high puncture accuracy, while it might affect the puncture accuracy when accompanied by extensive brain atrophy.

To explore the therapeutic effect and safety of robotic stereotactic assistant (ROSA robot)-assisted hematoma puncture combined with lateral ventricular drainage in the surgery of hypertensive brainstem hemorrhage.

A retrospective analysis was conducted on the clinical data of 18 patients with hypertensive brainstem hemorrhage admitted to the Department of Neurosurgery, Shanxi Provincial People′s Hospital from January 2019 to December 2020. All patients underwent hematoma puncture combined with lateral ventricular drainage under the assistance of ROSA robot. The Glasgow Coma Score (GCS) of 18 patients at admission was 4.7±1.7 points (3-8 points); the volume of hematoma was 9.7±4.3 ml (5.2-18.3 ml). There were 8 cases with hematoma breaking into the ventricle, 5 cases with hydrocephalus, and 10 cases with hematoma extending to the midbrain and medulla oblongata. The bone registration error of ROSA robot was 0.31±0.13 mm (0.14-0.59 mm). At the 3-month clinical follow-up, the Glasgow Outcome Scale (GOS) was used to assess the outcomes of patients. According to whether the patient survived at the last follow-up, the patients were divided into death group (5 cases) and survival group (13 cases). By comparing the clinical data of the two groups of patients, the possible factors related to death were explored.

All patients successfully underwent ROSA robot-assisted hematoma puncture and lateral ventricular drainage. There was no case of intracranial hemorrhage related to lateral ventricle puncture or drainage tube-related intracranial infection. The drainage tube of the hematoma cavity and the lateral ventricular drainage tube were removed within 3 to 7 days after surgery. All 18 patients were followed up. The GOS at 3 months post operation was: grade Ⅳ in 3 cases, grade Ⅲ in 6 cases, grade Ⅱ in 4 cases, grade Ⅰ in 5 cases. None of the 13 patients who survived post operation experienced rebleeding. Compared with the survival group, the patient’s GCS at admission was lower (3.4±0.5 points vs. 5.2±1.7 points, t=3.384, P=0.004) and preoperative hematoma volume was larger (13.4±4.0 ml vs. 8.3±3.5 ml, t=-2.640, P=0.018) in the death group. In terms of gender, age, whether the hematoma broke into the ventricle, whether the hemorrhage was accompanied by hydrocephalus, whether the hematoma extended to the midbrain or medulla, the time from onset to operation and the ROSA robot registration errors, there were no statistical differences between the survival and death groups (all P>0.05).

ROSA robot-assisted hematoma puncture combined with lateral ventricular drainage can accurately and effectively remove the hematoma caused by hypertensive brainstem hemorrhage with few complications. Brainstem hemorrhage patients with low GCS at admission to hospital and large hematoma volume have a relatively higher mortality rate.

To investigate the clinical application of percutaneous balloon compression (PBC) assisted by a neurosurgical navigation and positioning planning system (referred to as robot) for the treatment of trigeminal neuralgia.

A retrospective analysis was conducted on the clinical data of 13 patients with trigeminal neuralgia treated with robot-assisted PBC at the Department of Neurosurgery, General Hospital of Tianjin Medical University from March 2020 to November 2020. Preoperatively, all subjects underwent computed tomography (CT) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA). The surgical navigation and positioning planning system was used for multimodal image fusion and 3D reconstruction, loading of preoperative plan, and PBC surgery. The VAS (visual analogue scale) was used to assess the patient′s severity of pain before and after surgery, and the outcome was followed up at 1 month, 3 months and 6 months after surgery.

All 13 patients underwent robot-assisted PBC successfully and achieved immediate postoperative relief of trigeminal neuralgia. Their median VAS scores decreased from 10 (9-10) to 0. None of the patients experienced complications such as vascular injury, diplopia, ulcerative keratitis, and infection, while all reported postoperative numbness on the ipsilateral face. Two patients showed relief of facial numbness at 3-month follow-up. One patient presented with masticatory weakness on the surgical side at 1 month post operation, which was relieved at 6-month follow-up. At the final follow-up, the VAS score remained 0 in 13 patients, and there was no recurrence of pain in any of the patients.

Robot-assisted PBC surgery relies on navigation and robotic arm guidance for precise puncture of the foramen ovale and accurate placement of the balloon, which help improve the safety of surgery and reduce postoperative complications. Short-term follow-up reveals satisfactory results.

To explore the application values of modified registration and general anesthesia in robot-assisted deep brain stimulation (DBS).

A retrospective analysis was conducted on the clinical data of 315 patients who underwent robot-assisted DBS from September 2016 to March 2021 at the Department of Neurosurgery, General Hospital of the Northern Theater Command. All patients were implanted with DBS electrodes on both sides. According to different registration methods and methods of anesthesia, patients were divided into conventional registration plus local anesthesia group with 45 cases, modified registration plus local anesthesia group with 100 cases, and modified registration plus general anesthesia group with 170 cases. The differences in registration error, electrode implantation duration, electrode implantation deviation and perioperative complications of these three groups were compared.

Among 315 patients, the subthalamic nucleus was selected as the surgical target in 204 cases and the globus pallidus internus as the target in 111. There were no statistically significant differences in age, gender, onset time of disease, subclassification of disease or therapeutic target among these groups of patients (all P>0.05). The electrode implantation duration of the conventional registration plus local anesthesia group, the modified registration plus local anesthesia group, and the modified registration plus general anesthesia group were 2.1 ± 0.7 h, 1.5 ± 0.6 h, 1.0 ± 0.4 h respectively, and the registration errors were 0.82 ± 0.24 mm, 0.28 ± 0.05 mm, 0.26 ± 0.04 mm respectively, electrode deviations were 1.02 ± 0.36 mm, 0.67 ± 0.21 mm, 0.52 ± 0.14 mm respectively, and the differences were statistically significant (allP<0.01). A total of 315 patients suffered from microelectrode-related bleeding in 2 cases (0.6%), and 2 cases (0.6%) underwent reimplantation of electrodes, all of which were patients in the conventional registration plus local anesthesia group.

With the improvement of robot application technology, the accuracy, safety and implantation efficiency of its assisted DBS electrode implantation have been correspondingly improved.

To evaluate the technical feasibility and accuracy of augmented reality (AR)-assisted upper cervical pedicle screw implantation in 3D-printed pediatric models.

We randomly collected the cervical spine CT data of 8 children who underwent surgical treatment for cervical spine diseases at the Department of Neurosurgery of Xi′an International Medical Center Hospital from December 2019 to March 2021 and 2 children with normal cervical spine. The cervical spine model was 3D printed and made based on the cervical spine CT data. We imported the CT data into Mimics software to simulate and reconstruct the 3D model and design the needle entry point and trajectory. With the aid of AR equipment, 10 3D printed cervical spine models were implanted with screws on both sides of C₁-C₂ pedicles to simulate internal fixation. CT scan was performed after operation, and the accuracy of screw implantation was evaluated by Gertzbein-Robbins grading standard (level A and B revealed accurate implantation).

A total of 40 pedicle screws were implanted, and the accuracy of screw implantation was 100%. CT scans after screw implantation showed that the screws were in good positions and were completely inside the vertebral arch. Among them, 37 were grade A in Gertzbein-Robbins grade and 3 were grade B. Three screws penetrated the pedicle (all <2.0 mm), of which one penetrated the medial wall, 1 penetrated the inferomedial wall, and 1 penetrated the inferolateral wall. A total of 32 screws were implanted in 8 cervical spine models with cervical disorders, including 30 in Gertzbein-Robbins grade A; 2 normal cervical spine models were implanted with a total of 8 screws, of which 7 were in Gertzbein-Robbins grade A. There are no statistical differences between the two ( P=0.498).

The success rate and accuracy of AR technology-assisted pedicle screw implantation in 3D printed children′s upper cervical spine model simulating internal fixation operation are high, while its safety and effectiveness need to be confirmed by further clinical studies.

To explore the application of 5G mobile stroke unit in the diagnosis screening and emergency treatment of stroke.

The results of free diagnosis screening and treatment of 5G mobile stroke unit at the Stroke Center of Xing′an League People′s Hospital from October 2020 to January 2021 were retrospectively analyzed. Symptomatic treatment and health education were given to high-risk stroke patients identified by free diagnosis screening, who were instructed to monitor the blood pressure, and regular imaging reexamination was performed. Immediate real-time remote consultation was conducted or emergency patients and rescue strategies were formulated. Intravenous thrombolysis was performed on the spot for acute cerebral infarction. Patients treated in the emergency department were followed up clinically and radiologically, and their outcomes were assessed based on the Glasgow Outcome Scale (GOS).

A total of 173 patients were identified during screening, including 98 patients (56.6%) with low risk stroke and 75 patients(43.4%) with medium and high risk stroke. Forty-four patients were treated at the emergency department, including 25 cases of ischemic stroke, 11 cases of hemorrhagic stroke, 7 cases of others and 1 case of death without CT examination. The median time from the patient′s call for help to reaching the 5G mobile stroke ambulance was 71 min (9-167 minutes); the median time between admission to the ambulance and the start of CT scan was 5 min (1-31 min). Five out of those patients with ischemic stroke received intravenous thrombolysis in an ambulance. The 3-month follow-up of 43 emergency patients showed that the GOS of 5 out of 25 ischemic stroke patients undergoing thrombolysis was grade Ⅴ, and the head CT showed that the cerebral infarction area was significantly smaller or disappeared. Among the 20 patients who did not receive thrombolysis, 18 cases were successfully followed up and included 1 case of GOS grade Ⅰ, 9 cases of grade Ⅲ, 3 cases of grade Ⅳ, and 5 cases of grade Ⅴ. The head CT showed no significant change in the softening area of the cerebral infarction. Among the 11 patients with hemorrhagic stroke, there were 2 cases of GOS grade Ⅰ, 3 cases of grade Ⅲ, 4 cases of grade Ⅳ, and 2 cases of grade Ⅴ. Head CT showed that softening foci were formed in the bleeding area.

When 5G mobile stroke unit is employed for free diagnosis, it is easier to identify middle and high risk stroke patients. In emergency treatment, it can shorten the treatment time of stroke and ensure that patients receive effective treatment within the time window.

To explore the clinical manifestations, imaging features and prognosis of arterial ischemic stroke caused by focal cerebral arteriopathy in children.

A retrospective analysis was conducted on the clinical data of 15 children with focal cerebral arteriopathy who were admitted to the Department of Neurosurgery, Children′s Hospital of Fudan University from August 2016 to June 2020. The clinical manifestations, imaging features, treatment and outcomes of 15 children were summarized. The clinical follow-up was performed through outpatient clinic visits and telephone. The outcome of children′s neurological function was assessed based on the Pediatric Stroke Outcome Measure (PSOM), and the clinical and imaging follow-up results were used to assess whether the child had recurrence of stroke.

The median age of 15 children was 6.5 years (range: 1.9-12.8 years); 7 were males and 8 were females. The clinical symptoms included 12 cases of hemiplegia, 5 cases of aphasia, 3 cases of headache, and 1 case of epilepsy. The stenotic lesions were located in the internal carotid artery (ICA) C1-C7 segment in 5 cases, ICA C1-C7+ anterior cerebral artery (ACA) A1 + middle cerebral artery (MCA) M1 segment in 1 case, ICA C6-C7 + ACA A1 + MCA M1 segment in 7 cases, 1 case each in ACA A1 and MCA M1 segment. The infarctions and arterial lesions of 15 children were all located on the same side, including 10 on the left side and 5 on the right side. The infarction was located in the basal ganglia in 9 cases, in the frontal lobe in 6 cases, in the temporal lobe in 5 cases, in the parietal lobe in 5 cases, in the insula in 1 case, and in the thalamus in 1 case. Among them, 8 patients had cerebral infarction involving ≥2 lobes. The median score of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) at admission was 4 points (range: 0-10 points). All 15 patients underwent volume expansion therapy in the acute stage, 4 patients were treated with antiplatelet drugs in the convalescent stage, and 11 patients underwent clinical observation. All children were followed up, with a median follow-up time of 14.5 months (range: 3.5-58.4 months). The neurological function of 13 children had a good outcome (PSOM score <1 point), and 2 had a poor outcome (PSOM score of 1 point). During the follow-up period, there was no death or recurrence of arterial ischemic stroke.

Focal cerebral arteriopathy in children is a non-progressive disease. Hemiplegia is the most common clinical symptom. Arteriopathy is common in the ICA. After proper treatment, the clinical prognosis of children seems good.

To observe the effectiveness and safety of gamma knife for re-treatment of patients with drug-refractory trigeminal neuralgia (TN) who failed to respond to the first treatment or relapsed.

From June 2010 to September 2019, a total of 823 drug-refractory TN patients underwent gamma knife treatment at the Gamma Knife Center of Neurosurgery Department, West China Hospital, Sichuan University. Among them, 16 patients (1.9%) received gamma knife treatment again due to initial treatment failure or recurrence, and their clinical data were retrospectively analyzed. The Barrow Neurological Institute pain scale (BNI) was used to assess the degree of pain relief (grade Ⅰ-Ⅲb: effective, grade Ⅳ-Ⅴ: failed). The cranial nerve damage related to radiation therapy was followed up. Barrow Neurological Institute facial numbness score was used to evaluate the degree of facial numbness.

After the first treatment, 10 patients were effective and 6 were ineffective; the median effective time was 30 (1-180) days. The median time from first treatment to relapse was 28.4 (6-60) months. After re-treatment, 13 cases were effective and 3 cases were ineffective; the median effective time was 7 (1-180) days. The median follow-up time after retreatment was 30.5 (16-92) months, and 2 of the 13 effective cases had a complete recurrence of symptoms in the 3rd and 5th months after treatment. At the latest follow-up, 11 cases (11/16) were effective, the BNI pain grade Ⅰ was reported in 7 cases, Ⅱ in 2 cases, Ⅲ a in 1 case and Ⅲ b in 1 case. The BNI scores of 5 patients who failed or relapsed were all V. Among the 10 patients who were effective for the first treatment, 9 cases were effective after the second treatment; of the 6 cases that failed the first treatment, only 2 cases were effective after the second treatment (P=0.035). A total of 12 patients suffered radiation-related injuries during the two treatments. Among them, 11 cases had numbness on the same side and 2 cases had impaired taste. The median time from treatment to facial numbness was 2.5 (1-18) months, of which 7 cases were mild and 4 cases were moderate. The median maximum dose and margin dose for the first treatment were 85.0 Gy and 42.5 Gy, respectively, compared with 73.0 Gy and 36.5 Gy for the second treatment, and the differences were statistically significant (both P<0.001).

Gamma-knife treatment for relapsed or ineffective TN patients is still effective after re-treatment with gamma-knife. The incidence of complications is relatively high, but they are relatively mild. Among them, those who are effective for the first time may have better results after a second treatment.

To explore the clinical efficacy and intraoperative neuroprotection strategies of individualized selection of surgical approach and microsurgery for jugular foramen schwannoma (JFS) based on the modified Samii classification.

The clinical and imaging data of 28 patients with JFS admitted to the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019 were retrospectively analyzed. Before surgery, the tumors were classified into types A to D according to the modified Samii classification, and the surgical approach was individualized; 6 cases of type A tumors were treated with the suboccipital retrosigmoid approach, 2 cases of type B1 with the suboccipital transjugular process approach, 5 cases of type B2 with suboccipital retrosigmoid combined with transjugular process approach, 3 cases of type B3 with transjugular process and lateral cervical approach, 4 cases of type C with lateral cervical approach, and 8 cases of type D with suboccipital retrosigmoid approach combined with transjugular process and lateral cervical approach. All patients were followed up at 3, 6, and 12 months after the operation. Head MRI was performed to assess the degree of tumor resection, the House-Brackmann (H-B) grade was used to assess the severity of facial nerve palsy, and the patient′s modified Rankin Scale score (mRS) was assessed 12 months after surgery.

All 28 patients successfully underwent the operation. Total tumor resection was performed in 25 cases and subtotal resection in 3 cases. The perioperative cranial nerve complications mainly included 8 cases of aggravated palsy of the posterior cranial nerve and 2 cases of aggravated facial nerve palsy. There was no intracranial hematoma, second operation or death cases. The follow-up time of 28 patients was 35±9 months (12-70) months. At 12 months post operation, 16 cases had a score of 0 to 1, 9 cases were scored 2 and 3 cases were scored 3. At the last follow-up, 3 patients with subtotal tumor resection showed no tumor progression; 25 patients with total tumor resection did not develop tumor recurrence; posterior cranial nerve palsy remained in 5 patients, and there were 3 cases of facial nerve palsy with H-B grade above Ⅲ.

Based on the modified Samii classification and individualized selection of surgical approach, following the concept of minimally invasive skull base surgery, microsurgical treatment of JFS can achieve satisfactory clinical results.

To explore the factors and their predictive values related to the recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenomas.

A retrospective analysis was conducted on the clinical data of 646 patients who underwent endoscopic endonasal transsphenoidal resection of pituitary adenomas at the Department of Neurosurgery, Lanzhou University Second Hospital from January 2015 to January 2018. According to the latest follow-up, the patients were divided into non-recurrence group and recurrence group. Univariate and multivariate logistic regression methods were used to analyze the relevant factors affecting postoperative recurrence; receiver operating characteristic curve (ROC) was used to assess the predictive values of related risk factors for recurrence, and Bootstrap self-sampling method (1 000 times) was used as the verification set for internal verification.

The postoperative follow-up time of 646 patients was 48.4 ± 16.6 months (28.6-57.6 months), of which 82 (12.7%) patients relapsed. The results of multivariate logistic regression analysis showed that tumor invasiveness (OR = 6.616, 95%CI: 3.287-13.317), tumor proliferation (OR=8.842, 95%CI: 4.390-17.807), and large maximum tumor diameter (OR =7.878, 95%CI: 4.530-13.699) were risk factors for tumor recurrence after surgery, while total tumor resection (OR = 0.019, 95%CI: 0.003-0.100) was a protective factor for postoperative recurrence (all P<0.01). ROC results showed that the area under the curve (AUC) of the above factors predicting postoperative recurrence of patients was 0.931 (95%CI: 0.895-0.966), the sensitivity was 81.71%, and the specificity was 94.86%. Internal verification showed that AUC was 0.929 (95%CI: 0.893-0.964).

Larger maximum tumor diameter, tumor invasiveness, tumor proliferation and incomplete tumor resection are the risk factors of recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenomas, which have high predictive values for tumor recurrence.

To analyze the differential expression of circular RNA in children with cerebral palsy (CP), so as to explore the possibility of it as a marker for early diagnosis of CP.

A retrospective analysis was conducted on the clinical data of 5 children with CP diagnosed at the Neurosurgery Department of the Second Affiliated Hospital of Xinjiang Medical University from June 2017 to October 2018. At the same time, 5 healthy children matching gender, age, and ethnicity were collected, and their peripheral blood was collected. The expression profile of circular RNA in children with CP was detected by microarray technology. The differential expression level of circular RNA between the two groups was compared using independent sample t-test. The gene ontology enrichment analysis and the Kyoto Encyclopedia of Gene and Genome (KEGG) enrichment analysis were used to investigate the differentially expressed circular RNA, and to explore the relationship between the change of biological gene function of circular RNA and cellular pathways. During the same period, 20 children with CP (CP group) and 20 healthy children (healthy group) were randomly selected, and their peripheral blood was collected. Quantitative real-time polymerase chain reaction (qRT-PCR) technology was used for further verification of circular RNA with significant differences in expression.

Among 5 pairs of children with CP and healthy children, we found a total of 53 586 differently expressed circular RNAs, and a total of 45 differentially expressed circular RNAs were screened, of which 43 were up-regulated and 2 were down-regulated (fold change ≥2.0, P<0.05). Gene ontology enrichment analysis indicated that the biological functions of circular RNA were related to neurogenesis, neuronal differentiation, regulation of developmental processes, and cell cycle regulation. KEGG enrichment analysis revealed that circular RNA might be related to the cAMP signaling pathway, endoplasmic reticulum protein processing, and the signaling pathway regulating the pluripotency of stem cells. The results of screening and verifying 3 circular RNAs showed that hsa_circ_0062733 (fold change=3.20,P=0.010) had good specificity in qRT-PCR.

There are a large number of differentially expressed circular RNAs in children with CP compared with healthy children. It has been verified that hsa_circ_006273 is differentially expressed and up-regulated in children with CP, and hsa_circ_006273 may become a potential biomarker for early diagnosis of CP.

To explore the key genes that affect the malignant progression of glioma and the survival of patients, and to study their expression characteristics and clinical significance in gliomas.

A retrospective analysis was conducted on the clinical data and the sequencing data of 310 cases of Chinese glioma genome atlas (CGGA) RNA sequencing database, 699 cases of cancer genome atlas (TCGA) RNA sequencing database, 268 cases of GSE16011 database and 317 cases of REMBRANDT mRNA database to screen out the differential genes related to patient prognosis, and the target gene was determined through literature search. The expression characteristics of the gene were evaluated in the above four databases. Kaplan-Meier survival curve and Cox regression analysis were used to evaluate the effect of this gene on the outcomes of patients with glioma. Through the Pearson correlation test, the genes in the CGGA and TCGA databases that were significantly positively correlated with the target gene expression (r>0.5 andP<0.05) were screened out. We used the online software DAVID to analyze the biological function enrichment of the differentially expressed genes. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of this gene in astrocytic cell lines and glioma cell lines. Cellular immunofluorescence staining was used to detect the expression of γ-H2AX protein in glioma cell lines (U87, U251 and LN229) after drug treatment.

After screening, histone cluster 1 H2B family member H(HIST1H2BH) was decided as the target gene. In the above four databases, the expression levels of HIST1H2BH in the WHO Ⅱ, Ⅲ and Ⅳ gliomas were statistically significant (all P<0.01), of which the expression was the highest in level Ⅳ gliomas, and the lowest in level Ⅱ gliomas; and the expression of HIST1H2BH in isocitrate dehydrogenase (IDH) wild-type glioma was higher than that in IDH mutant glioma (allP<0.001). In the CGGA and TCGA databases, the overall survival rates of patients with all grades of glioma and glioblastoma in the high-expression group of HIST1H2BH was lower than those of the low-expression group (allP<0.05). The results of univariate and multivariate Cox regression analysis showed that the expression of HIST1H2BH was an risk factor affecting the overall survival of patients with glioma (HR=1.275, 95%CI: 1.040-1.563, P<0.05). The results of biological function enrichment analysis showed that genes that were significantly positively related to the expression of HIST1H2BH were mainly involved in cell proliferation, DNA damage repair and extracellular matrix regulation. The qRT-PCR results showed that the relative expression levels of HIST1H2BH in HA, U87, U251 and LN229 cell lines were significantly different (1.03±0.03, 1.62±0.08, 3.41±0.27, 2.86±0.20, respectively,P<0.05) . The results of cellular immunofluorescence showed that the expression of γ-H2AX protein in U87 cell line after treatment with temozolomide was higher than those in U251 and LN229 cell lines (P<0.05).

The expression of HIST1H2BH in glioma increases with the pathological grade of glioma. It is a risk factor affecting the survival of glioma patients, which may be related to its participation in DNA damage repair that causing drug resistance of tumor cell.

Professor Chen Gongbai, former Dean of Huashan Hospital affiliated to Fudan University, Director of Institute of Neurology and Director of Clinical Neurophysiology Research Unit, tragically passed away from myocardial infarction on August 8, 2021 at the age of 88.