Volume 38 · Issue 04 · 2022

To evaluate the safety and efficacy of transvenous curative embolization(TVE) for the treatment of intracranial arteriovenous malformations (AVM).

A retrospective study was conducted on the clinical data of 54 BAVM patients who underwent TVE at the Cerebrovascular Disease Center, the First Affiliated Hospital of Naval Military Medical University from October 2016 to August 2021. The preoperative modified Rankin scale (mRS) score was 0-2 points in 42 patients (77.0%), and 3-4 in 12 patients (23.0%). Immediate post-embolization results, procedure-related complications, and follow-up findings of patients were documented.

Among the 54 patients, 50 (92.6%) underwent successful TVE, and 4(7.4%) did not undergo TVE because the microcatheter failed to reach the draining vein. Among the 50 patients, immediate postoperative complete embolization was achieved in 45 cases (90.0%) and subtotal embolization in 3 cases (6.0%), partial embolization was achieved in 2 cases (4.0%). Hemorrhagic complication was found in 9 patients (18.0%), among which 3 were asymptomatic, 2 cases presented with only headache, and the other 4 required surgical intervention. Ischemic complication was found in 8 cases (16.0%), among which 7 were transient. Permanent procedure related complications occurred in 5 patients (10.0%) . At discharge, the mRS score was 0-2 points in 33 patients (66.0%), and 3-5 points in 17 cases (34.0%). Forty-two patients received imaging follow-up, with a median follow-up period of 5.5 (3.8, 13.3) months [M (Q₁, Q₃)]. Complete occlusion was found in 39 cases (92.9%), 2 (4.8%) of residual nidus was found stable over time, and 1 case (2.4%) had recurrence. All 50 patients received clinical follow-up, with a median follow-up period of 25.5 (8.8, 38.0) months [M (Q₁, Q₃)], mRS scored 0-2 in 42 cases (84.0%), and 3-5 in 8 cases (16.0%).

Transvenous curative embolization of intracranial AVM has a high rate of complete embolization and a relatively low rate of permanent procedure-related complications.How to further improve surgical safety is still challenging.

To preliminarily explore the outcomes of transjugular embolization of brain arteriovenous malformations (AVM) involving the posterior circulation (vertebrobasilar system).

A retrospective analysis was conducted on the clinical data of 14 patients with posterior circulation AVM who were treated by transjugular embolization in the Department of Cerebrovascular Diseases, Interventional Treatment Center, Henan Provincial People′s Hospital from November 2016 to April 2021. The patients were followed up for 30 to 90 days after operation in the outpatient department for neurological complications. The modified Rankin scale (mRS) was used to evaluate the outcomes, and mRS≤2 was regarded as a good outcome. Cranial MRI and digital subtraction angiography (DSA) were re-examined 90-180 days after operation, and complete embolization was defined as no early venous drainage vein on DSA.

Among the 14 patients, 13 underwent successful transjugular embolization. Immediate postoperative angiography indicated complete embolization in 11 patients and incomplete embolization in 2. Embolization failed in 1 patient. There were 6 cases of cerebral hemorrhage and 1 case of cerebral infarction within 1 week after operation. One patient of cerebral hemorrhage died. At discharge, the mRS score was 0 in 1 case, 1 in 5, 2 in 4, and 5 in 3. At the 90-day follow-up after operation, 1 case was lost to follow-up, and among the remaining 12 patients, 11 had a good outcome and 1 had a poor outcome. Imaging follow-up was performed in 10 patients, and the follow-up time was 8.8±3.3 months (3-30 months). The results showed that 8 patients achieved complete embolization, 1 patient had recurrent diffuse vascular malformation, and 1 patient still had a small amount of residual vascular mass.

Preliminary observation has suggested that the technique of transjugular embolization of posterior circulation AVM is feasible and can be used as a supplementary treatment method for traditional surgery with good therapeutic effect.

To investigate the success rate, safety and efficacy of transvenous embolization of superficial intracranial arteriovenous malformations (AVM).

A retrospective analysis was conducted on the clinical data of 21 patients with superficial intracranial AVM who underwent transvenous embolization in the Cerebrovascular Disease Center of the First Affiliated Hospital of Naval Military Medical University from January 2017 to June 2021. Among the 21 patients, modified Rankin Scale score(mRS) was 3 points in 2, 2 in 2, 1 in 14 and 0 in 3. Sixteen underwent transvenous embolization alone, and the other 5 underwent endovascular embolization through transvenous and transarterial combined approach. Immediately after the operation, digital subtraction angiography (DSA) was performed to determine the degree of embolization of the malformed vascular mass. After discharge, clinical and anpiographic follow-up were performed for all patients. The follow-up contents included: re-examination of DSA to determine whether the malformed vascular mass recurred; mRS to evaluate the outcome of patients, for whom the mRS ≤ 2 indicated good outcome and the mRS>2 indicated poor outcome.

All 21 patients underwent successful operation, and the technical success rate was 100%. Immediate postoperative DSA results showed that 19 patients achieved complete embolization of the malformed vascular mass, and the other 2 patients achieved subtotal embolization. Transient ischemic complications occurred in 1 case, and bleeding complications occurred in 2 cases after operation. MRI examination was performed within 48 hours after operation, and 2 cases (2/10) developed asymptomatic venous edema. The anpiographic follow-up time of 21 patients [M(Q₁, Q₃)] was 6(4, 15) months. The results of re-examination of DSA showed that 1 patient had recurrence, and the other 20 patients were completely cured. The clinical follow-up time of 21 patients[M(Q₁, Q₃)] was 33(5, 40) months.The mRS results showed that 19 patients had a good outcome and the other 2 had a poor outcome.

Transvenous embolization for superficial located AVM has a high success rate, and the safety still needs further research and exploration.

To explore the application of pressure cooker technique (PCT) in transvenous embolization of intracranial arteriovenous malformations (AVM).

The clinical data of 4 patients with intracranial AVM who underwent transvenous embolization by PCT in the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University from March 2016 to March 2021 were retrospectively analyzed. Cranial CT or MRI was reviewed within 7 days after operation to determine the bleeding or ischemic complications. Outpatient follow-up was performed at 1, 3, 6, and 12 months after operation, and the outcome of the patients was evaluated by the modified Rankin scale (mRS), in which 0-2 indicated good outcome, and >2 indicated poor outcome.

All 4 patients underwent successful operations. Immediate postoperative DSA showed that 3 patients were completely cured, and the other 1 patient had an embolization area of ≥90% AVM. One patient died of cerebral herniation due to intraventricular hemorrhage after operation, and the remaining 3 patients had no postoperative complications. Three patients were followed up, and the follow-up time [M (range)] was 13 (8-16) months. At the last follow-up, all 3 patients had good outcomes. The mRS score of 1 was reported in 2 patients and that of 0 was reported in 1.

Preliminary findings show that PCT is effective in embolizing intracranial AVM via transvenous approach, with fewer postoperative complications, but further research and verification are needed.

To observe the safety and efficacy of transarterial embolization of intracranial arteriovenous malformations (AVMs) by the pressure cooker technique (PCT).

A retrospective analysis was conducted on the clinical and imaging data of patients with BAVMs who underwent transarterial embolization by PCT in the Department of Neurosurgery, the Second Affiliated of Air Force Medical University from January 2019 to November 2021. A total of 42 cases were enrolled into this study. The complete embolization rate and surgery-related complications of AVMs immediately after embolization were observed. The clinical outcomes were assessed by modified Rankin scale (mRS), and the patients underwent imaging follow-up of digital subtraction angiography (DSA) at 1 year after operation.

A total of 43 operations were performed in 42 patients. The total number of embolizations was 87, and the median number of embolization was 2 (1-5). Among them, 52 embolizations were performed using PCT, and the median number of embolization was 1 (1-3). Immediate postoperative angiography showed that 26 (61.9%) patients underwent complete embolization and 16(38.1%) underwent partial embolization. Six cases (14.2%) had surgery-related complications. Among them, 1 case of cerebral infarction and 1 case of transient ischemic attack did not have any permanent neurological deficit; 4 cases of cerebral hemorrhage underwent hematoma drainage (1 case) or combined craniotomy for hematoma removal and AVM resection(3 cases) who had permanent neurological deficit remaining after operation. The median postoperative follow-up time was 11.5 months (1-34 months), and there was no rebleeding in the patients. At 1 year after operation, 38 cases (90.5%) had good outcome (mRS ≤ 2 points) and 4 (9.5%) had poor outcome (mRS>2 points). At 1 year after operation, 10 patients were followed up by DSA. Among the 7 patients with complete embolization, 6 patients had no recurrence, and 1 patient had local recurrence. Three patients had partial embolization, and there was no significant change in their lesions.

The immediate embolization rate of intracranial AVMs treated by transarterial embolization by PCT through is acceptable, and the incidence of complications is low.

To explore the efficacy of endovascular therapy based on the new classification of unit structure of the intracranial arteriovenous malformations (AVM).

A retrospective analysis was conducted on the clinical data of 458 patients with intracranial AVM admitted to the Department of Neurosurgery, Guangdong Provincial People′s Hospital (Guangdong Academy of Medical Sciences) from February 2017 to December 2020. According to the unit structure classification method developed in our previous study, intracranial AVM were classified and included 32 cases of type Ⅰ, 37 cases of type Ⅱ, 45 cases of type Ⅲ, 109 cases of type Ⅳ, and 235 cases of type Ⅴ. Individualized endovascular treatment methods were used according to different types, and their therapeutic effects and safety were summarized.

The overall cure rate of 458 patients was 44.3% (95% CI: 0.40-0.49). In this series, the cure rates of types Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ were 84.4% (27/32) and 94.6% (35/37), 95.6% (43/45), 31.2% (34/109) and 27.2% (64/235). The incidence of postoperative overall dysfunctional complications was 6.1%(28/458)(95% CI: 0.04-0.08). Specifically, there were 7 cases of technical complications (25.0%), 4 cases of hemorrhagic complications (14.3%) and 17 cases of ischemic complications (60.7%).

Based on the unit structure, intracranial AVM can be divided into five types, and individualized endovascular treatment with reference to this classification has relatively good efficacy and few complications.

To investigate the role of endovascular embolization in hybrid surgical resection of high-grade arteriovenous malformations (AVM).

A retrospective analysis was conducted on the clinical data of 22 patients with high-grade (Spetzler-Martin grade Ⅳ, Ⅴ) AVM who underwent hybrid surgery (endovascular embolization + lesion resection) from January 2016 to November 2019 in the Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University (16 cases) and the Neurosurgery Department of Peking University International Hospital (6 cases). According to the specific conditions of the supplying arteries, all patients underwent embolization of the malformed vascular mass first, and then resection. The neurological function of the patients during the perioperative period and postoperative follow-up was evaluated by modified Rankin scale (mRS). Imaging follow-up was performed by head CT angiography (CTA) or digital subtraction angiography (DSA).

The malformed vascular mass was completely obliterated in 22 patients. The operation time was 447.5±152.1 min (270-905 min) and the mean intraoperative blood loss was 700 ml (range: 100-6 000 ml). The incidence of perioperative complications was 31.8% (7/22), which included 5 cases of limb movement impairment (including 2 cases of postoperative muscle weakness caused by hematoma), 1 case of mutism, and 1 case of transient aphasia. The follow-up time of 22 patients was 28.2±7.1 months (14.8-38.3 months), of which 19 patients (86.4%) had good outcomes (mRS≤2 points), and the remaining 3 patients (13.6%) had poor outcomes (mRS≥3 points). Fourteen patients (63.6%) received imaging follow-up and the follow-up time was 22.8±18.6 months (3.4-62.4 months). No recurrence of AVM was identified in the last follow-up.

Endovascular embolization-assisted microsurgical resection in the treatment of high-grade AVM can not only reduce intraoperative bleeding, reduce the incidence of complications, but also increase the obliteration rate of lesions, thereby improving the outcomes of patients.

To label the function of Crus-Broca (CB) tracts originating from bilateral cerebellar Crus lobes and targeting into Broca′s complex by analyzing spatial relationship between endpoints of their streamlines and Broca activated region of language-related resting-state network (LaRSN) at subject level.

Resting-state functional MRI data of 26 healthy subjects from Human Connectome Project (HCP) Lifespan Pilot Project-1a database were analyzed to obtain Broca activated regions in native space. The proportion of each of five subregions of Broca′s complex of HCP multi-modal parcellation version 1.0 atlas (i.e. HCP 74, 75, 76, 77 and 171 areas) of each subject covered by Broca activated region was determined. The streamlines of CB tracts targeting into Subregions_covered and Subregions_uncovered were comparatively analyzed.

The proportions of HCP 74, 75, 76, 77 and 171 covered by Broca activated region were (71.0±25.1)%, (70.1±25.1)%, (74.1±20.7)%, (47.0±27.9)% and (61.4±30.3)% at group level respectively, indicating that the first three Broca subregions had a high degree of concordance with the Broca activated region. The proportion of streamlines of CB tract targeting into Subregions_covered was greater than that of Broca Subregions_covered in Broca activated region (P=0.002). The density of streamlines of CB tract targeting into Subregions_covered was greater than that targeting in corresponding Subregions_uncovered (P=0.002). Those above indicated that CB tracts tended to target into Broca activated region within Broca′s complex.

Preliminary studies have shown that the CB tract is involved in the LaRSN through the Broca activated area, and it should be included in the preoperative brain function assessment system for cerebral and cerebellar lesions involving language function.

To investigate the clinical effect of deep brain stimulation (DBS) of the globus pallidus internus (GPi-DBS) for the treatment of primary cervical dystonia.

The clinical data of 14 patients with cervical dystonia treated with GPi-DBS in the Neurosurgery Department of the Second Affiliated Hospital of Air Force Medical University from October 2014 to April 2019 were retrospectively analyzed. The device of DBS was turned on at 1 month after the operation, and all patients were followed up in outpatient clinics at 1, 3, 6 months, 1 year and every year thereafter. Follow-up contents included: observation of hardware-related complications; the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [including: Torticollis Severity Scale (TSS), Disability Scale (DS) and Pain Scale (PS)] score to assess the improvement of the patient′s symptoms. The calculation formula of improvement rate was: (preoperative score-postoperative score)/preoperative score×100%, of which ≤30% was regarded as mild improvement, >30%-60% as moderate improvement, and >60% was significant improvement.

All 14 patients underwent successful operations, and there were no postoperative complications such as intracranial hemorrhage and infection. A total of 28 electrodes were implanted (on 28 sides), of which the monopolar stimulation mode was applied in 13 electrodes, and the double-monopolar (two cathodes) stimulation mode in 15 electrodes. The follow-up time of 14 patients was 33.7±12.4 months (12-53 months) after the DBS device was turned on. During the follow-up period, 2 patients developed dyskinesia in the lower extremities, and the symptoms were improved by adjusting the stimulation parameters. With the extension of follow-up time, TSS, DS and PS scores all showed a decreasing trend (all P<0.001); torticollis symptoms, disability and pain symptoms were significantly improved 3 months after the device was turned on. At the last follow-up, there was no statistically significant difference in the TSS, DS or PS scores compared with the patients′ conditions at 1 year after the device was turned on (all P>0.05). At the last follow-up, the TSS scores of 14 patients were as follows: 1 case was mildly improved, 6 cases were moderately improved, and 7 cases were significantly improved. In the DS score results, 2 cases were mildly improved, 2 cases were moderately improved, and 10 cases were significantly improved. In the PS results, 14 cases were significantly improved.

GPi-DBS treatment of primary cervical dystonia has fewer complications, significant improvement in torticollis and pain symptoms, and prolonged effect.

To explore the long-term efficacy of deep brain electrical stimulation (DBS) for the treatment of spastic torticollis (ST).

A retrospective analysis was conducted on the clinical data of 53 patients with TS who underwent DBS surgery from June 2012 to December 2019 in the Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital. Among the patients, 3 were complicated with Parkinson′s disease. According to clinical symptoms and comorbidities, 49 patients underwent DBS of bilateral globus pallidus internus (GPi), 2 patients underwent DBS of bilateral subthalamic nucleus (STN), 1 patient underwent DBS of bilateral STN and GPi targets, and 1 patient underwent DBS of bilateral thalamic ventral intermediate nucleus (Vim) targets. The Western Toronto Spastic Torticollis Rating Scale (TWSTRS) and Tsui Scale scores of the patients were followed up postoperatively to assess the improvement of the patients′ symptoms.

Intraoperative MRI of the 53 patients showed that the positions of implanted electrodes were consistent with the surgical plans. Surgical complications included 1 case of external capsule hemorrhage occurring during operation; 1 case of postoperative cerebral infarction and 1 case of scalp wound infection. At 2 years after operation, 1 patient developed wire pulling feeling in the neck area. The follow-up time of 53 patients was 40.5±19.8 months. By the last follow-up, the improvement rates of TWSTRS and Tusi scale scores [M (Q₁, Q₃)] in 49 GPi-DBS patients were 59.4% (51.0%, 72.3%) and 61.7% (54.4%, 73.9%) respectively. Compared with preoperative conditions, those two scores were decreased (Z values: -6.29 and -6.21 respectively, both P<0.001). The improvement rates of TWSTRS scores in 2 patients who underwent STN-DBS were 100% and 71.6% respectively, and the improvement rates of Tusi scale scores were 100% and 83.3% respectively. The improvement rates of TWSTRS and Tusi scale scores in 1 patient with Vim-DBS were 92.3% and 50.0% respectively. In 1 patient with bilateral STN- and GPI-DBS, the improvement rates of TWSTRS and Tusi scale scores were 72.5% and 100%, respectively.

The long-term efficacy of DBS in the treatment of ST seems good, and the patients′ neck posture, neck pain, and quality of life could be significantly improved.

To explore the surgical strategy and clinical effect of blood flow alteration and revascularization in the treatment of giant cavernous carotid aneurysms.

A retrospective analysis was conducted on the clinical data of 20 patients (20 aneurysms in total) with symptomatic giant cavernous carotid aneurysms (diameter ≥2.5 cm) who were admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from March 2012 to August 2019. Head CT angiography(CTA), digital subtraction angiography(DSA), balloon occlusion test and cerebral perfusion imaging were performed and comprehensively evaluated preoperatively. Individualized surgical strategy was designed based on comprehensive preoperative assessment. Among the 20 patients, 2 underwent internal carotid artery (ICA) ligation, 11 underwent ICA constriction, 2 underwent high flow bypass combined with ICA ligation, 1 underwent medium flow bypass combined with ICA ligation, and 4 underwent low flow bypass combined with ICA constriction. The patients were followed up regularly for CTA or DSA after surgery, and the outcomes were evaluated based on the modified Rankin scale (mRS).

The aneurysms disappeared in 5 cases, decreased in size in 11 cases and remained unchanged in size in 4 cases. Three patients developed focal cerebral infarction postoperatively. 18 cases were followed up, and 2 cases were lost to follow-up. The imaging follow-up time was 7.8±3.0 months (range: 3-12 months), and the aneurysms disappeared in 7 cases, shrunk in 9 cases, and had no change in size in 2 cases. At the follow-up for an average of 46.3±16.3 months (20 to 85 months), 16 patients′ symptoms disappeared or relieved, and 2 patients did not have relief. The mRS score at the last follow-up were 0 in 9 cases, 1 in 8 cases and 3 in 1 case.

Flow alteration coupled with revascularization is an effective method for the treatment of symptomatic giant cavernous carotid aneurysms. Individualized surgical strategy based on the status of collateral circulation can achieve a good prognosis with few complications.

To generate glioblastoma (GBM) organoid models and to investigate the inhibitory effect of radiotherapy, chemotherapy and hypoxia inducible factor-2α (HIF-2α) inhibitor on GBM using the models.

The brain tissue samples of glioma and non-glioma patients were obtained from patients undergoing surgical treatment at the Department of Neurosurgery, Xiangya Hospital, Central South University, and the primary tumor cells were derived from the brain tissue samples of GBM patients and U-251 cell line. The GBM organoids and GBM neurosphere models were generated. The cells were cultured for 30 days, and the growth of GBM organoids and GBM neurosphere cells was observed; immunofluorescence staining was used to detect the expression of tumor stem cell markers, and immunohistochemical staining was used to detect glioma specimens and non-glioma brain tissue specimens, HIF-2α expression in GBM adherent cells and GBM organoids. On the 30th day of cell culture, GBM organoids were divided into non-radiotherapy group and radiotherapy group. Each group was further divided into dimethyl sulfoxide (DMSO) group, temozolomide (TMZ) group and HIF-2α inhibitor group. In the radiotherapy group, the cells were irradiated with 6 Gy X-rays and cultured for 30 d. The passage efficiency and HIF-2α expression of cells in each group were observed.

After 30 days of cell culture, GBM organoids were about 2 mm in diameter, with dense cells at the outer edge and loosely arranged in the center; while GBM neurospheres were about 200 μm in diameter, with evenly distributed cells in the center and edge. Immunofluorescence staining showed that the expression levels of SOX2, CD133 and epidermal growth factor (EGFR) in the outer edge of GBM organoids were higher than those in the central part. The expression of SOX2 was positive in GBM neurospheres, and there was no difference in the expression of the whole spheroids; the expressions of CD133 and EGFR were both negative. Non-tumor brain tissue does not express HIF-2α; high-grade gliomas have stronger HIF-2α expression than low-grade gliomas. The expression of HIF-2α in GBM organoids was mainly distributed near necrotic cells; the expression of HIF-2α in GBM adherent cultured cells was more evenly distributed. In the radiotherapy group and the non-radiotherapy group, the cell passage efficiency of the HIF-2α inhibitor group and the TMZ group was lower than that of the DMSO group (both P<0.05). The cell passage efficiency in the DMSO group and TMZ group was decreased, and the difference was statistically significant (both P<0.05), while the difference in the HIF-2α inhibitor group was not statistically significant (P=0.301). Immunohistochemical staining showed that in the non-radiotherapy group and the radiotherapy group, the expression of HIF-2α in the DMSO group and TMZ group did not decrease except the HIF-2α inhibitor group.

The tumor heterogeneity of GBM organoids is closer to the tumor tissue. HIF-2α is related to the malignancy of glioma. The tumor suppressive effects of radiotherapy and chemotherapy are not through the inhibition of HIF-2α.

To study the effect of B7-H3 on the proliferation, invasion and migration of glioblastoma (GBM).

The expression data of B7-H3 in GBM, low-grade glioma (LGG) and normal brain tissue in GEPIA database were collected, and the differences and their relationship with patient survival were analyzed. GBM cell lines A172 and TG-905 with low expression of B7-H3 (shRNA-B7-H3 group) were constructed by transfecting short hairpin RNA (shRNA), and real-time quantitative PCR (qRT-PCR), flow cytometry and Western blotting (WB) were used to detect the expression of B7-H3 to verify the knockdown efficiency. The control groups were untransfected wild-type cells (wt group) and transfected with control shRNA (shRNA-ctl group). Carboxyfluorescein diacetate succinimidyl ester (CFSE) staining assay, cell counting kit-8 (CCK-8), and colony formation assay were used to detect cell proliferation ability after B7-H3 knockdown. Scratch healing experiment and Transwell chamber method were used to detect cell migration and invasion ability after B7-H3 knockdown. WB was used to detect the expression of downstream signal molecules after B7-H3 knockdown.

The GEPIA database analysis results showed that the expression of B7-H3 in LGG and GBM tissues was higher than that in normal brain tissues (both P<0.01), and patients with low expression of B7-H3 had a longer survival time (P<0.001). In the A172 cell line, the results of qRT-PCR and flow cytometry showed that the expression level of shRNA-B7-H3 group was lower than that of shRNA-ctl group and wt group (both P<0.01). WB results showed that the expression level of shRNA-B7-H3 group was lower than that of shRNA-ctl group and wt group. CFSE results showed that the cell proliferation ability of the shRNA-B7-H3 group was lower than that of the shRNA-ctl group at 24, 48, and 72 h (all P<0.001). The results of both CCK-8 and colony formation assay showed that the proliferation ability of shRNA-B7-H3 group was lower than that of shRNA-ctl group and wt group (both P<0.05). The results of the scratch healing experiment showed that the scratch healing ability of the shRNA-B7-H3 group at 48 h and 72 h was lower compared with that of the shRNA-ctl group and the wt group (all P<0.01). The results of Transwell chamber experiments showed that after B7-H3 knockdown, the migration and invasion abilities were decreased (both P<0.001). WB results showed that the expression of cyclin-dependent kinase 4 (CDK4) and phosphorylated Janus kinase 2 (p-JAK2) was down-regulated after B7-H3 knockdown, while the expression of Bcl-2-related protein (Bax) was up-regulated. The above experiments revealed similar results in TG-905 cells.

B7-H3 promotes the proliferation, invasion and migration of GBM by up-regulating CDK4, p-JAK2 and down-regulating Bax.