Volume 38 · Issue 11 · 2022

To investigate the short-term efficacy of bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi) combined with capsulotomy of the anterior limb of the internal capsule (ALIC) in the treatment of Tourette syndrome (TS) with comorbid obsessive-compulsive disorder (OCD).

Five TS patients with OCD were treated with GPi-DBS combined with ALIC capsulotomy at the Department of neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2021 to September 2021. The short-term safety and clinical efficacy were analyzed retrospectively. The scores of Yale Global Tic Severity Scale (YGTSS) and Yale Brown Obsessive-Compulsive Scale (Y-BOCS) were used to evaluate the improvement of tic symptoms and OCD respectively.

The implantation of electrodes into the GPi and the ALIC capsulotomy were successfully completed without perioperative adverse events. During the postoperative test period, the improvement rates of YGTSS and Y-BOCS score were (49.1±26.2)%(16.0%-91.2%) and (68.9±29.4)% (38.2%-100.0%) respectively. At 2-6 months after the impulse generator was turned on, the improvement rates of YGTSS and Y-BOCS scores were (48.6±26.7)% (18.7%-91.2%) and (61.6±38.1)% (11.8%-100.0%)respectively. None of the patients developed permanent complications after GPi-DBS combined with ALIC capsulotomy.

Preliminary observation has shown that GPi-DBS combined with ALIC capsulotomy can improve the tic symptoms and OCD of TS patients in a short time. The long-term efficacy still needs further follow-up.

To investigate the efficacy of deep brain stimulation of the subthalamic nucleus (STN-DBS) in the treatment of advanced Parkinson′s disease (PD).

Twenty-eight patients with advanced PD who received STN-DBS at the Neurosurgery Department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2015 to October 2019 were enrolled. Postoperative overall and classified scores of Unified PD Rating Scale Part Ⅲ (UPDRS-Ⅲ), improvement of non-motor symptoms, improvement of levodopa equivalent daily dose (LEDD) and drug complications were evaluated retrospectively.

One year after operation, the LEDD[M(Q₁, Q₃)] was 393.8 (250.0, 500.0) mg, which was significantly different compared with 812.5 (750.0, 1 168.9) mg before operation (P<0.001). The incidences of drug-induced wearing-off effect, dyskinesia and on-off phenomenon were all decreased (all P<0.05). The total score of UPDRS-Ⅲ at 1 month and 1 year after operation was 15.0 (9.3, 18.0) points and 26.0 (21.3, 28.0) points respectively, which were significantly different compared with 37.0 (35.0, 43.8) points before operation (both P<0.001). In terms of the UPDRS-Ⅲ classified items, the scores of resting tremor, postural tremor, limb movement, bradykinesia, and posture were significantly improved at 1 month and 1 year after operation, and the differences were statistically significant (all P<0.001). However, the scores of rigidity, speech, countenance and gait were significantly improved only at 1 month after operation (all P<0.001), and the difference was not statistically significant at 1 year after operation (all P>0.05). The dysphagia score showed a worsening trend (P=0.006). Some non-motor symptoms improved at 1 year after operation (all P<0.05).

STN-DBS significantly improves motor symptoms in patients with advanced Parkinson′s disease in the short term, and has limited effect on some motor symptoms and non-motor symptoms at 1-year follow-up after surgery. It can also reduce drug-related complications.

To investigate the effectiveness, safety and factors influencing the efficacy of microvascular decompression for the treatment of primary glossopharyngeal neuralgia (GPN).

The clinical data of 61 patients with GPN who underwent microvascular decompression at the Department of Neurosurgery, Peking University People′s Hospital from January 2014 to November 2019 were retrospectively analyzed. The Barrow Neurological Institute (BNI) pain intensity scale was applied to assess the pain degree of all patients before and after treatment. Friedman′s test and Wilcoxon signed-rank sum test were used to analyze the changes in pain level before and after surgery. Univariate analysis and multivariate logistic regression analysis were used to explore the potential factors affecting postoperative pain relief, and a regression model was established. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.

Among the 61 patients, 52 patients (85.2%) had complete relief of pain immediately after surgery, 4 patients (6.6%) had significant relief, 3 patients (4.9%) had partial relief, and 2 patients (3.3%) had no relief. Two years after operation, 41 cases (67.2%) of pain were completely relieved, 7 cases (11.5%) were significantly relieved, 9 cases (14.7%) were partially relieved, and 4 cases (6.6%) were not relieved. The BNI pain intensity scores of patients immediately after operation and 2 years after operation were significantly improved compared with those before operation, and the differences were statistically significant (both P<0.01). Multivariate logistic regression analysis showed that low-grade neurovascular compression (OR=9.29, 95%CI: 1.87-46.15, P=0.006) and venous compression (OR=10.53, 95%CI: 1.91-58.22, P=0.007) were independent risk factors for pain relief after MVD for GPN. The Hosmer-Lemeshow test indicated that the model based on independent risk factors had a good fit (χ²=0.56, P=0.453). Permanent complications occurred in 4 patients (6.6%), including 2 patients (3.3%) with pharyngeal foreign body sensation, 1 patient (1.6%) with hoarseness, and 1 patient (1.6%) with ipsilateral mild hearing loss.

Microvascular decompression can effectively and safely relieve the pain symptoms of GPN patients, but there is a certain probability of recurrence. Patients with GPN with mild neurovascular compression and venous compression are less likely to experience pain relief after microvascular decompression.

To explore the reasons for the recurrence or ineffectiveness of primary trigeminal neuralgia (PTN) after microvascular decompression (MVD), as well as the method and efficacy of re-craniotomy.

The clinical data of 36 patients with recurrent or ineffective PTN after MVD surgery who were treated by the same surgeon in the Department of Neurosurgery of China-Japan Friendship Hospital from August 2020 to February 2022 were retrospectively analyzed. According to intraoperative findings, the causes of recurrence or ineffectiveness were divided into adhesion and compression of trigeminal nerve (type Ⅰ), omission of offending vessels (type Ⅱ), incomplete decompression (type Ⅲ) or misjudgment of offending vessels (type Ⅳ), and " granulomatous" changes caused by implanted materials (type Ⅴ). For different reasons, strategies such as separation of adhesions, MVD surgery, and removal of " granulomatous" mass were adopted. The Barrow Neurological Institute (BNI) pain scale was used to evaluate the efficacy, and postoperative BNI pain score ≤ 2 was defined as an excellent surgical outcome.

All patients successfully underwent the operation. The recurrence or ineffectiveness cause was type Ⅰ in 22 cases (61.1%), type Ⅱ in 7 cases (19.4%), type Ⅲ in 3 cases (8.3%), type Ⅳ in 2 cases (5.6%), and type Ⅴ in 2 cases (5.6%). In this series, 47% (17/36) of patients had varying degrees of facial or ipsilateral anterior tongue numbness after surgery, which gradually eased after 3 to 6 months. The follow-up time of 36 patients was (10.2±3.7) months (3-16 months). To the last follow-up, the postoperative BNI pain score of 36 patients was 1 point in 34 cases, 2 points in 1 case, and 4 points in 1 case (improved to 2 points after balloon compression therapy). There was no case of recurrence. The rate of excellent and good outcomes was 97% (35/36).

For patients with recurrent or ineffective PTN after MVD surgery, the recurrence or ineffectiveness causes can be divided into 5 types according to the intraoperative findings of reoperation. It is safe and effective to use specific surgical methods according to different etiologies.

To explore the feasibility of quantitative assessment of intraoperative bradykinesia using Leap motion Controller (LMC) during deep brain stimulation (DBS) for Parkinson′s disease (PD).

A prospective study was conducted on 14 patients with PD treated with bilateral DBS in the Department of Neurosurgery of Tianjin Huanhu Hospital from May 2020 to March 2021. The LMC was used to collect data on the motor tasks of finger tapping (FT), hand opening and closing (OC), hand pronation and supination (PS) before surgery and after implantation of DBS electrodes. Each action was repeated 10 times, the velocity (V), frequency (F), and amplitude peaks (A) over the full action cycle were extracted, and the means (、 and ), the trend (ΔV、ΔF and ΔA) and the coefficient of variation (V_CV、F_CVand A_CV) were calculated. The LMC data were collected at the time as the assessment by physicians according to the third part of Movement Disorder Society-Sponsored Revision of the Unified Parkinson′s Disease Rating Scale (MDS-UPDRS-Ⅲ) 3.4 to 3.6 items. Nine indicators in the 3 tasks before and during operation were compared respectively, and the correlation analysis was carried out between the 9 indicators and the corresponding MDS-UPDRS-Ⅲ item scores.

All 14 patients completed the documentation of movements, and the 152 actions including 23 groups of FT, 27 groups of OC, and 26 groups of PS were analyzed by statistics. The 、V_CV、、A_CV of FT, 、ΔA、A_CV of OC, 、V_CV、、ΔA、A_CV of PS in the intraoperative conditions improved compared with preoperative conditions, and the differences were statistically significant (all P<0.05). The 、V_CV、F_CV、、A_CV of FT, 、ΔV、V_CV、、F_CV、ΔA、A_CV of OC, and 、ΔV、V_CV、F_CV、、ΔA、A_CV of PS were all correlated with the MDS-UPDRS-Ⅲ corresponding scores (all P<0.05).

Preliminary studies have suggested that LMC can be applied to quantitative evaluation of FS, OC and PS during DBS surgery.

To explore the application value of open-source 3D slicer in frame-based stereotactic brain biopsy (SBB).

Patients who were diagnosed with intracranial space-occupying lesions and underwent frame-based SBB at the Neurosurgery Department of the Second Affiliated Hospital of Xi′an Jiaotong University from November 2019 to December 2021 were prospectively enrolled. Before operation, 3D Slicer were used for all the patients to perform multi-modal registration of medical images such as CT and MRI. Intracranial lesions, vessels, ventricles, as well as brain tissues were reconstructed and fully displayed in a three-dimensional window. Then the target within the lesion was preset and its three-dimensional coordinates were calculated. The optimal puncture path was simulated and the SBB was performed according to this predefined trajectory. The accuracy and safety of 3D slicer assisted SBB were evaluated by postoperative CT.

A total of 22 patients were included in this study. The 3D reconstruction by 3D Slicer provided a good visualization for intracranial lesions, vessels, ventricles, sulci and gyri in all the included patients. The puncture target was designed according to the location of the lesion. Among the 22 patients, the targets were preset in the frontal lobe in 8 cases, the basal ganglia and thalamus in 6 cases, the parietooccipital lobe in 3 cases, the temporal lobe in 2 cases, the area near posterior horn of the lateral ventricle in 2 cases, and the sellar region in 1 case. All the stereotactic brain biopsies were successfully completed according to the preoperative simulated puncture plans. Postoperative CT showed that all biopsy sampling sites were located in the lesion, and the sampling sites were consistent with the preset targets. Patients had no bleeding, infection or new neurological dysfunction. Postoperative pathological diagnosis revealed 11 gliomas, 3 lymphomas, 2 demyelinating lesions, 2 metastatic adenoma, 1 germ cell tumor, 1 ependymoma, 1 craniopharyngioma and 1 necrotic inflammation.

3D Slicer could provide guarantees for the accuracy and safety of frame-based SBB and reduce the operation risk.

To investigate the influencing factors of facial nerve outcome after microsurgical resection of vestibular schwannoma and to establish the predictive models.

A retrospective analysis was conducted on the clinical data of 129 patients with vestibular schwannoma who underwent tumor resection via retrosigmoid approach at Department of Neurosurgery, Xiangya Hospital, Central South University from June 2018 to March 2020. The facial nerve function was assessed using the House-Brackmann (H-B) scoring system before operation, immediately after operation and 6 months after operation. Multivariate logistic regression analysis was used to explore the influencing factors affecting the outcome of facial nerve function. Based on the influencing factors of facial nerve function obtained from logistic regression analysis, the mathematical predictive models for postoperative outcome of facial nerve function were then established.

The results of multivariate logistic regression analysis showed that the tumor size, preoperative facial nerve function, TFIAC classification, age and lower cranial nerve dysfunction may be the influencing factors for immediate postoperative facial nerve function (all P<0.10). The area under the receiver operating curve (AUC) of the prediction model for immediate postoperative nerve function based on the above-mentioned influencing factors was 0.830 and 0.713 in the training set and test set, respectively, with prediction accuracy of 77% and 71%. The independent influencing factors affecting the facial nerve function outcome 6 months after operation included the age, tumor size, preoperative facial nerve function, cerebellar symptoms, lower cranial nerves dysfunction (all P<0.05). Another possible influencing factor (i.e., Samii classification) was also included to establish the 6-month postoperative prediction model. In the training set and test set, the AUC of prediction model was 0.861 and 0.894, respectively, with prediction accuracy of 77% and 78%.

The predictive models for facial nerve function immediately and 6 months after microsurgery for vestibular schwannoma based on multivariate logistic regression analysis results seem to have relatively high prediction accuracy and certain guiding significance for clinical individualized treatment plan.

To preliminarily investigate the clinical effect of extracranial-intracranial high flow bypass surgery for the treatment of large and giant aneurysms of internal carotid artery (ICA).

A retrospective analysis was conducted on the clinical data of 10 patients with large and giant ICA aneurysms who were admitted and treated by extracranial-intracranial high flow bypass surgery at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from April 2017 to February 2021. A total of 11 aneurysms were identified in 10 patients, including 8 in the cavernous sinus segment, 2 in the cavernous sinus and supraclinoid process segment, and 1 in the communicating segment. Among the 10 patients, 8 cases underwent extracranial-intracranial high flow bypass plus aneurysm isolation; 2 cases underwent extracranial-intracranial high flow bypass plus proximal occlusion of the parent artery, and 1 patient with bilateral aneurysms underwent treatment only on the ruptured side. The patency of the donor vessels was assessed by CT angiography (CTA). The clinical outcome was evaluated by the modified Rankin Scale (mRS).

All operations were successful, and intra-operative indocyanine green fluorescence angiography and DSA showed that the patency rate of vascular anastomosis was 100%. After operation, 1 case had mild aphasia and right limb paralysis, 1 had decreased vision in the right eye, and 1 had TIA (transient ischemic attack). The follow-up time of 10 patients was 35.8±16.6 months (11-60 months). At 6 months after operation, except 1 case with visual impairment who had no recovery, the other 2 cases recovered significantly in terms of complications. The mRS score was 0 in 8 cases, 1 in 1 case and 2 in 1 case. The CTA of 3-6 months post operation showed only 1 case of graft occlusion, and the graft vessel showed patency in other cases.

Extracranial-intracranial high-flow vascular bypass + aneurysm isolation or proximal occlusion of the parent artery for the treatment of intracranial complex aneurysms has a high technical success rate and patency rate of the graft vessels, fewer complications and a relatively favorable outcome.

To explore the application value of multi-channel sacral reflex monitoring in trans-channel microsurgical resection of lumbosacral spinal tumors.

A retrospective study was conducted on the clinical data of 60 patients with intraspinal tumor of thoracic 12 (T₁₂) and below who underwent trans-channel microsurgical resection at the Department of Neurosurgery, Union Hospital of Fujian Medical University from January 2018 to December 2020. During the operation, all patients underwent multi-channel sacral reflex monitoring. The stimulating electrodes were fixed on the dorsal area of the penis (clitoris in women), and the recording electrodes were placed in the external anal sphincter, external urethral sphincter (the urethrovaginal sphincter in women), bulbocavernosus muscle respectively. and/or the ischiocavernosus muscle. Simultaneous monitoring of motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs) and electromyography (EMGs) was performed. The Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were used for assessment before surgery, 7 days, 14 days and 6 months after surgery.

Among 60 patients, a total of 62 operations were performed, 67 channels were established, and 69 lesions were removed. Tumors were completely removed in 55 patients and mostly removed in 5 patients. The waveform changes of 33 cases of sacral reflex, 28 cases of MEP, 26 cases of SEP, and 39 cases of EMG reached the warning standard during operation. There was significant difference in the JOA score among pre-operation, 7 days, 14 days and 6 months post operation(F=109.40, P<0.05). The JOA scores at 7 d, 14 d and 6 months post operation were significantly different compared with that prior to operation (all P<0.05). The results of JOA assessment at 6 months post operation showed that 10 cases (16.7%) were cured, 48 cases (80.0%) were markedly effective and 2 cases (3.3%) were effective. There was significant difference in the VAS score among pre-operation, 7 days, 14 days and 6 months post operation(F=245.10, P<0.05). The VAS scores at 7 d, 14 d and 6 months post operation were significantly different compared with that prior to operation (all P<0.05). The results of VAS evaluation at 6 months post operation showed that 6 cases (10.0%) were cured, 45 cases (75.0%) were markedly effective, 9 cases (15.0%) were effective, and the proportion of excellent and good outcomes was 85.0% (51/60).

Multi-channel sacral reflex monitoring can monitor the integrity of pudendal sensory nerve, motor nerve and sacral spinal cord function, which is beneficial to protect the integrity of urinary and sexual function-related nerve conduction pathways in patients undergoing trans-channel microsurgical resection of lumbosacral spinal canal tumors.

To explore the application value of intracranial pressure (ICP) monitoring in traumatic brain injury (TBI) with multiple injuries.

A retrospective analysis was conducted on the clinical data of 301 patients of TBI combined with multiple injuries patients who were admitted to the Department of Neurosurgery at the Second Hospital of Tianjin Medical University and the 904^th Hospital of Joint Logistic Support Force of PLA from January 2016 to December 2020. The patients were divided into ICP monitoring group (93 cases) and non-ICP-monitoring group (208 cases) according to whether ICP was monitored. The differences in the rate of craniotomy, the total amount of blood transfusion, the dosage and time of dehydrating agent, the number of examination transfers, the total hospitalization days, the incidence of complications, and the Glasgow Outcome Scale (GOS) at 6 months after injury were compared between the two groups.

None of the 93 patients who received ICP monitoring (ICP group) developed ICP-related serious complications. Compared with the non-ICP group, the rate of craniotomy in the ICP group was lower [30.1% (28/93) vs. 46.2% (96/208)], the total volume of blood transfusion was lower, the total doses of mannitol and hypertonic saline infusion were smaller, the infusion time was shorter, the examination transfer times was less, the incidences of electrolyte disorder [14.0% (13/93) vs. 29.3% (61/208)] and renal insufficiency [8.6% (8/93) vs. 18.8% (39/208)] were lower, the total hospitalization days [(18.7±6.0) days vs. (21.3±7.5) days] were less, and the differences in the indicates as above were statistically significant (all P<0.05). The incidence of deep vein thrombosis, intracranial infection or operation on other injured parts had no significant difference between the two groups (all P>0.05). All patients were followed up for 7.5±2.4 months (6-12 months) after discharge. The GOS difference between the two groups was statistically significant (P=0.001), and the mortality rate of the ICP group was lower than that of the non-ICP group [6.5% (6/93) vs. 14.9% (31/208), P=0.039].

For TBI with multiple injuries, the application of ICP monitoring could better control ICP, reduce the incidence of related complications and effectively reduce the mortality rate.

To observe the inhibitory effect of radiotherapy and monoclonal antibody-targeted blocking immune checkpoint molecule CEACAM1 (carcinoembryonic antigen-associated cell adhesion molecule) on glioma in situ in mice and its effect on immune response in mice.

We collected the clinical data of primary glioma patients who consecutively underwent operation and radiotherapy within 1 month in the Department of Neurosurgery of the First Hospital of Shanxi Medical University from March to December 2019. The expression of CEACAM1 on the surface of T lymphocytes in the peripheral blood of glioma patients before and after radiotherapy was detected respectively. GL261 glioma cells (stably transfected with luciferase gene) were implanted in the right caudate nucleus of the brain of C57BL/6 mice, and a small animal in vivo imaging system was used to observe the growth of the tumor. At the same time, the mice were divided into the isotype control group, the radiotherapy group, the anti-CEACAM1 group and the combined treatment group (n=5 in each group); the survival of the mice after treatment was observed. Immunohistochemical test was performed to detect the expression level of CEACAM1 in mouse brain gliomas before and after radiotherapy. Flow cytometry was performed to detect the expression levels of CD4⁺, CD8⁺ and regulatory T cells (Tregs) in mouse brain infiltrating T lymphocytes. The expression levels of serum interferon γ (IFN-γ) and interleukin 10 (IL-10) in mice were detected by enzyme-linked immunosorbent assay (ELISA).

Compared with before radiotherapy, the expression level of CEACAM1 on the surface of CD4⁺ T lymphocytes in the peripheral blood of glioma patients was significantly increased at 1 week after radiotherapy (P<0.05), and the expression level was further increased at 1 month after radiotherapy (P<0.05). There was no significant change in the expression level of CEACAM1 on the surface of CD8⁺ T lymphocytes 1 week after radiotherapy (P>0.05), and its expression level increased 1 month after radiotherapy (P<0.05). The combined treatment group could significantly inhibit the growth of gliomas in mice and prolong their survival period, and the survival period of some mice (2/5) in this group was more than 90 days (P<0.05). The results of immunohistochemistry showed that compared with before radiotherapy, there was no significant difference in the expression of CEACAM1 in mice 1 week after radiotherapy (P>0.05), but compared with before radiotherapy and 1 week after radiotherapy, the expression level of CEACAM1 increased significantly at 1 month after radiotherapy. high (both P<0.05). The results of flow cytometry showed that compared with the control group of the same type, the ratio of infiltrating CD8⁺ T lymphocytes in the brain of the mice in the combined treatment group increased, the ratio of Treg cells decreased, and the ratio of CD8⁺ T/Treg increased (all P<0.05). The ELISA results showed that the expression level of IFN-γ in the peripheral blood of mice in the combined treatment group increased, while the expression level of IL-10 decreased (both P<0.05).

Radiotherapy combined with CEACAM1 inhibitor therapy can generate a strong and durable anti-tumor immune response against gliomas in mice, and prolong the survival of some mice.

To investigate the effects of brain-derived neuropeptide S (NPS) on osteogenesis and differentiation-related proteins of rat nasal ectomesenchymal stem cells (EMSCs).

The nasal mucosa of 6-week-old female Sprague Dawley rats was cultured to obtained EMSCs, and the fourth generation EMSCs were selected for related experiments. Nestin and vimentin, the surface markers of EMSCs, were detected by immunofluorescence to identify EMSCs. NPS were added to EMSCs for co-culture, and the EMSCs were divided into normal saline group (control group), 200 ng/ml NPS group and 400 ng/ml NPS group. The expression of Ki-67 in EMSCs was observed by immunofluorescence staining after 8 h of NPS treatment to evaluate the effect of NPS on the proliferation of EMSCs. EMSCs were cultured in osteogenic induction medium for 14 days to observe the effect of NPS on the osteogenic differentiation of EMSCs: alkaline phosphatase (ALP) kit was used to detect the activity of ALP; Alizarin red staining (ARS) was used to observe the mineralization level; the expression levels of osteopontin (OCN), osteocalcin (OPN), collagen Ⅰ (COL Ⅰ), NPS receptor (NPSR) and Runx-2 were detected by Western blot and immunofluorescence.

Immunofluorescence showed that nestin and vimentin were positive in nasal mucosa. The results of immunofluorescence showed that there was no significant difference in the expression of Ki-67 among the control group, 200 ng/ml NPS group and 400 ng/ml NPS group (P>0.05). The results of ALP activity detection and ARS showed that there was no significant difference in ALP activity and calcium nodule expression between the 200 ng/ml NPS group and the 400 ng/ml NPS group (both P>0.05), but they were higher than those in the control group. (all P<0.01). Western blot test showed that NPSR, Runx-2, COL Ⅰ and OPN in 200 ng/ml NPS group and 400 ng/ml NPS group were higher than those in the control group (all P<0.05), and there was no significant difference in the above proteins between 200 ng/ml NPS group and 400 ng/ml NPS group (all P>0.05). Immunofluorescence results showed that compared with the control group, the expressions of OCN, COL Ⅰ, OPN and Runx-2 in 400 ng/ml NPS group were significantly increased, which was consistent with the results of Western blot test.

NPS can promote the differentiation of EMSCs into osteoblasts, and its mechanism may involve the activation of NPSR, promoting the translocation of Runx-2 to the nucleus as well as enhancing its expression level, starting the process of osteogenic differentiation and increasing the expression level of osteogenic related proteins.

To investigate changes of skull diameters, skull thickness and brain volume and the expression of local focal adhesion kinase (FAK) during the growth and development of the calvaria of rats and to explore the markers of the rapid growth period of the skull.

SD rats were used in this study. Data were collected from 1 to 12 weeks after birth. The diameters of their heads were measured (Line A: Connecting the tip of the nose to the posterior occipital tuberosity; Line B: Connecting the two orbital margins perpendicular to line A; Line C: Connecting the two mandibular angles; Line D: Connecting the outer edges of the two orbits). After the rats were euthanized, the calvaria on both sides were peeled off, and the brain volume and skull thickness were measured with a graduated cylinder and a vernier caliper, respectively. The mRNA and protein expression levels of FAK in skull tissue were detected by real-time PCR and Western blot method.

(1) Skull diameter line: Line A changed most obviously, and the growth rate was faster from 1 to 7 weeks, and from 2 to 7 weeks, the difference was statistically significant compared with that of the previous week (all P<0.05), and the growth flattened out after the seventh week. The growth of line B was relatively stable. In the second week, line C and line D both increased significantly compared with those of the previous week (both P<0.05), and the growth of the two lines became stable after the second week. (2) Thickness of calvaria: There was almost no thickening of calvaria at 1 to 2 weeks, but the thickness increased significantly at 3 to 8 weeks compared with those of the previous week (all P<0.05), and the increase in thickness became stable after 8 weeks. (3) Brain volume: The brain volume increased rapidly from 1 to 3 weeks (P<0.001), and became stable after the third week. (4) Correlation analysis results of brain volume and calvaria thickness: The increase of brain volume was positively correlated with calvaria thickening (R=0.90, P=0.001). (5) Changes of FAK mRNA and protein expression: During the developmental process, the mRNA and protein expression of FAK gradually increased, reaching the highest value at the 10th week (both P<0.05), and then gradually became stable, the expression trend of protein and mRNA was consistent.

The expression trend of FAK in the calvarial tissue of rats from 1 to 12 weeks after birth is consistent with the growth and development of the calvaria, indicating that FAK may be involved in the growth and development of the calvaria after the rapid growth of the brain.