Volume 39 · Issue 03 · 2023

In 2022, the American Society of Vascular Surgery (SVS) released the "Guidelines for the Clinical Treatment of Extracranial Carotid Artery Stenosis". Based on evidence-based medical evidence in related fields, the guidelines made a detailed analysis of five controversial hot issues in clinical practice, and gave comprehensive treatment suggestions, which are highly practical. This article combines the relevant literature to interpret the guide for reference.

To explore the clinical efficacy of lateral atlantoaxial joint distraction combined with joint remodeling technique in the treatment of basilar invagination complicated with atlantoaxial dislocation.

A retrospective analysis was conducted on the clinical data of 12 patients with basilar invagination and atlantoaxial dislocation who were diagnosed and treated at the Spine Center, Sanbo Brain Hospital, Capital Medical University from October 2019 to September 2021. All cases had comorbid occipitalization of the atlas and the clivus canal angle decreased. In all patients, the lateral joint was distracted by interarticular distraction, and then the joint was remodeled to adjust the tilt angle of the joint surface. The cage was then inserted to rotate the atlas upward and backward, and internal fixation was performed. The clinical outcomes of all patients were assessed using the Japanese Orthopedic Association (JOA) scale. The atlantodental interval, Chamberlain′s line invasion, clivus canal angle, and cervicomedullary angle were measured before and after surgery.

All patients successfully underwent reconstruction of the articular surface and screw implantation. All patients underwent occipital-C₂ internal fixation. The operation time was 191.7 ± 46.9 min, the intraoperative blood loss was 182.5 ± 69.3 ml, and there was no vertebral artery or dura mater injury. Within one week after surgery, CT showed reduction of atlantoaxial dislocation in all 12 patients. Chamberlain′s line invasion decreased from 10.0 ± 3.5 mm before operation to 4.2 ± 2.3 mm after operation, and atlantodental interval decreased from 6.7 ± 2.1 mm before operation to 1.4 ± 0.8 mm after operation. MRI showed that the angular displacement of odontoid process was corrected in all patients. The clivus canal angle increased from 136.9± 5.1° before operation to 150.2±3.5° after operation, and the cervicomedullary angle increased from 129.8± 5.5 °before operation to 146.5± 4.3° after operation. The differences were statistically significant (P<0.01). Postoperative imaging showed that 1 patient had lower C1 articular surface collapse, while no nerve injury symptoms appeared. The follow-up time was 17.8±4.5 months (12-25 months). At the last imaging follow-up, the odontoid downward movement remained corrected in all patients, showing atlantoaxial interarticular bone fusion. No complications such as screw extraction or cage displacement occurred. At the last clinical follow-up, the JOA score increased from 11.8±2.3 points before surgery to 15.1±1.2 points after surgery, and the difference was statistically significant (P<0.01).

The atlantoaxial joint distraction combined with joint remodeling technology can effectively increase the clivus canal angle and cervicomedullary angle, reduce the compression on the ventral side of the brain stem, and contribute to the reduction of atlantoaxial dislocation.

To investigate the therapeutic effect of posterior atlantoaxial joint distraction and fusion technique in the treatment of basilar invagination (BI)-atlantoaxial dislocation (AAD) complicated with syringomyelia.

The data of 43 patients with BI-AAD and syringomyelia who underwent posterior atlantoaxial joint distraction and fusion at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from August 2017 to August 2021 were retrospectively analyzed. The implanted fusion device was evaluated by X radiography. The chamberlain line violation (CLV) and atlantodental interval (ADI) were measured in the sagittal cervical CT. The cervicomedullary angle (CMA) and syringomyelia rate were measured on the mid-sagittal cervical MRI. The Japanese Orthopaedic Association (JOA) score was used to evaluate the patients' improvement of neurological functions.

All 43 patients underwent successful operation without implant failure, cage subsidence, infection or other complications. The follow-up time [M (Q₁, Q₃)] of 43 patients was 6 (3, 9)months, preoperative CLV was 12.8±3.8 mm, and postoperative CLV was 5.8±4.0 mm (t=-0.51, P<0.001). The ADI [M (Q₁, Q₃)] increased from 5.0 (4.2, 5.8)mm prior to operation to 1.3 (0, 2.7) mm post operation (Z=-5.70, P<0.001). The CMA increased from 129.3±9.9° prior to operation to 151.0±8.4° post operation (t=7.81, P<0.001). The syrinx/cord (S/C) ratio [M (Q₁, Q₃)] decreased from 67.9% (48.0%, 75.5%) prior to operation to 41.6% (23.1%, 53.6%) post operation (Z=-5.53, P<0.001). Negative correlation was identified between CMA and S/C ratio (r=-0.44, P<0.001). At the last follow-up, the patient′s JOA score [M (Q₁, Q₃)] increased from 12.5 (11.0, 14.0) to 14.5 (13.0, 15.3) (Z=-5.73, P<0.001).

Posterior atlantoaxial joint distraction and fusion technology can safely and effectively treat BI combined with AAD. After releasing the ventral compression, the syringomyelia is obviously relieved, and the neurological function is improved. The technique has good clinical therapeutic effect.

To assess the efficacy and safety of direct posterior reduction in the treatment of congenital basilar invagination (BI) complicated with atlantoaxial dislocation (AAD).

A retrospective analysis was conducted on the clinical data of 31 patients with BI combined with AAD treated at the Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2018 to August 2021. The C1 assimilation was observed in all 31 patients. The C_2-3 fusion (Klippel-Feil syndrome) and Chiari malformation was revealed in 16 patients (51.6%) and 10 patients (32.2%) respectively. All patients underwent reduction and occipitocervical fixation and fusion using a direct posterior approach. The preoperative and postoperative radiological measurements included anterior atlantodental interval (ADI), Chamberlain′s line violation (CLV), clivus-canal angle (CCA) were documented and compared using paired t-test. Clinical and imaging follow-up were performed. Neurological function 6 months after surgery was evaluated using the JOA scale. Bone fusion was evaluated based on CT results during follow-up period.

All patients underwent surgery successfully. None of the cases had severe surgical complications such as cerebral infarction or aggravation of neurological dysfunction. Compared with those prior to operation, ADI (6.2±0.6 mm vs. 2.2±0.3 mm, t=8.52, P<0.001) and CLV (11.3±3.0 mm vs. 3.1±0.5 mm, t=12.65, P<0.001) decreased, while the CCA (125.6°±6.5° vs. 140.7°±5.0°, t=5.28, P<0.001) increased post operation. Occipital plate loosening was found in 1 case, postoperative reduction was lost in 2 case and one patient suffered from infection in donor site of iliac crest bone graft. All patients were followed up. At 6 months post operation, the mean JOA score significantly improved from 11.2±3.1 to 14.3±2.5 (t=12.81, P<0.001). Reduction of the syrinx size and regression of tonsillar herniation were observed in the patients which were preoperatively diagnosed with concomitant tonsillar herniation and/or syringomyelia on MRI at 3 months after surgery. CT examination indicated that all patients achieved bone fusion at 6 months after surgery.

The direct posterior approach for the treatment of congenital BI with AAD is safe and efficient with few complications.

To analyze the clinical characteristics and risk factors affecting survival of patients with high-grade spinal cord astrocytoma.

A retrospective analysis was conducted on the clinical data of 96 patients of spinal cord high-grade astrocytoma (WHO grade 3/4) who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from March 2011 to December 2021. The Kaplan-Meier method was used to estimate the survival period and survival rate; the log-rank test was used to analyze the effects of age, sex, course of disease, tumor location, length of involved vertebral segments, resection degree, WHO grade, H3K27M mutation and postoperative adjuvant radiotherapy and chemotherapy on survival period. Some of the above indicators (P<0.10) were included in the multivariate Cox regression model for analysis.

The median age of the 96 patients was 35 years old (7-63 years old), and 58.3% (56) of the patients were 18-45 years old; the median duration of the disease was 5.5 months (1-60 months), and 67.7% (65 cases) of the patients had the duration of disease which was ≤ 6 months. Tumors were more likely to occur in cervical enlargement (34.4%, 33 cases) and conus medullaris (30.2%, 29 cases) of the spinal cord. The median number of the vertebral segments involved with tumor was 3 (1-9) and 51.3% (51 cases) of the patients had the tumor resection degree of ≥50%. Those with WHO grade 4 accounted for 81.3% (78 cases), and those with H3K27M gene mutation accounted for 75.0% (72 cases). The median follow-up time was 50.5 months (range: 2.7-133.0 months), 8 patients (8.3%) were lost to follow-up, and 22 patients (23%) survived at the last follow-up. The overall median survival time was 18.6 months, and the 1-, 2-, and 5-year survival rates were 64%, 48%, and 15%, respectively. The results of log-rank test showed that patients with the tumor length of > 3 vertebral segments, WHO grade 4 tumor and tumor resection degree of < 50% had shorter survival time (all P<0.05). The patient′s age, gender, disease duration, tumor location, postoperative adjuvant radiotherapy or chemotherapy had little effect on the patient′s survival (all P>0.05). Multivariate regression Cox analysis showed that WHO grade 4 (HR=2.56, 95%CI: 1.01-6.50, P=0.047) and tumor length of > 3 vertebral segments (HR=1.99, 95%CI: 1.16-3.42, P=0.024) were independent risk factors for poor outcomes of patients.

The findings suggest that high-grade astrocytomas of the spinal cord have some unique clinical and biological features. The overall prognosis of patients is poor, and the prognosis of patients with WHO grade 4 and tumor length of > 3 vertebral segments seems even worse.

To investigate the surgical outcomes of elderly patients with meningiomas.

The clinical data of 101 patients with meningiomas treated by neurosurgery at the Department of Neurosurgery, Beijing Jishuitan Hospital from January 2015 to December 2020 were retrospectively analyzed. McCormick grade was used to evaluate the spinal cord function of patients before operation, 7 days and 3 months after operation. The degree of tumor resection was evaluated by Simpson grading system. The difference between preoperative and postoperative McCormick grades was used to evaluate the improvement of spinal cord function of patients after surgery. According to the age, the elderly group (23 cases) was aged ≥ 70 years old, and the control group (78 cases) was aged<70 years old. The baseline data, surgical efficacy and complications of the two groups were compared.

There was no statistically significant difference between the two groups in the gender, preoperative clinical symptoms, duration of symptoms, tumor segment, tumor location, maximum tumor diameter, tumor calcification, or preoperative McCormick grade (all P>0.05). Compared with the control group, the elderly group had higher ASA (American Society of Anesthesiologists) grade and more types of complications (both P<0.05). Compared with pre-operation, the McCormick grading of patients in the elderly group and the control group showed a downward trend at 7 days and 3 months after operation (Z value: 35.52 and 125.10 respectively, both P<0.001). There was no significant difference between the two groups in the degree of tumor resection (Simpson grade), the McCormick grade 7 days and 3 months after surgery, and the degree of improvement of spinal cord function after surgery (all P>0.05). In terms of complications, there was no significant difference in the incidence of cerebrospinal fluid leakage [4.3% (1/23) vs. 1.3% (1/78)], incision bleeding [0 vs. 1.3% (1/78)] and incision infection [0 vs. 1.3% (1/78)] between the elderly group and control group (all P>0.05).

Surgical treatment for elderly patients with meningiomas is safe and effective and can improve the spinal cord function.

To investigate the method and efficacy of neuroendoscopic surgery for the treatment of symptomatic sacral Tarlov cysts.

A retrospective review was performed on the clinical data of 32 patients with symptomatic sacral Tarlov cysts who were admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Naval Military Medical University from February 2019 to February 2022. All patients underwent neuroendoscopic surgery. The inlet fistula was blocked by a small piece of myofascial tissue, and the cyst cavity was filled with autologous adipose tissue. The visual analog scale (VAS) was used to evaluate the pain level of the patients before surgery, 1 day after surgery, and 3 months after surgery. The change of cystic cavity was evaluated by lumbrosacral MRI. The improvement of neurological dysfunction, including skin sensation, lower limb muscle strength, feces and urine, and sexual function, was evaluated by physical examination.

The operations of 32 patients with symptomatic sacral Tarlov cysts were successful, and no operation-related complications occurred. Of the 31 patients with pre-operative sacrococcygeal and/or lower extremity pain, 27 (87.1%) had significant pain relief post operation. The VAS score prior to operation, at 1-d and 3-month follow-up was 5.59±1.48, 2.50±1.05 and 1.94±0.80 respectively. The postoperative VAS score was significantly lower than that before surgery (F=206.33, P<0.001). All 32 patients underwent MRI reexamination within 1 month after surgery, and the results showed that cerebrospinal fluid signals in the cystic cavity had been converted into fat signals. The MRI reexamination at 3 months post operation showed that the fat in the cystic cavity had been partially absorbed in 10 patients. At the 3-month follow-up, the improvement rate of skin paresthesia, fecal and urinal dysfunction and sexual dysfunction was 4/7, 3/5, 2/3 and 1/1 respectively. Of the 7 patients whose muscle strength was grade Ⅳ before surgery, 2 patients recovered to grade Ⅴ after surgery.

The myofascial closure of the leakage of symptomatic sacral Tarlov cysts and the fat filling of cystic cavity can significantly improve the pain symptoms and neurological dysfunction of the patients, with little surgical trauma and high effective rate. The technique has a relatively good clinical therapeutic effect.

To explore the application value of minimally invasive percutaneous decompression via contralateral approach in the treatment of lateral lumbar spinal stenosis with degeneration of small lamina.

A retrospective analysis was conducted on the clinical data of 15 patients with lateral lumbar spinal stenosis with degeneration of small lamina who underwent minimally invasive percutaneous decompression via contralateral approach at the Department of Neurosurgery, the 904^th Hospital of PLA Joint Logistic Support Force from September 2019 to December 2020. We compared the width of lamina fenestration post operation with the distance from the root of spinous process to the dorsal articular surface prior to operation in the suprapedicle notch section CT, and evaluated the abrasion of bilateral facet joints after operation. The change of transverse and sagittal diameters of dural sac based on MRI results were analyzed. Regular clinical follow-up was performed after operation. The improvement of visual analogue scale (VAS) score, Japanese orthopedic association (JOA) score and Oswestry dysfunction index (ODI) post operation were evaluated based on the comparison with their pre-operative values. The stability of lumbar spine was determined by imaging follow-up.

All 15 patients successfully underwent the operation. There was no case of nerve injury, cerebrospinal fluid leakage or post-operative infection. The operation time was 74.9±13.6 min (60-100 min), the volume of intraoperative blood loss was 25.9±10.1 ml (15-50 ml). Post-operative CT showed that the width of contralateral lamina fenestration was 9.0±1.2 mm, which was less than the distance from the root of spinous process to the dorsal articular surface (13.1±1.2 mm) (P<0.05). The residual width of ipsilateral articular surface (16.8±1.8 mm) and contralateral articular surface (15.6±1.7 mm) were greater than 2/3 of the pre-operative articular surface width (ipsilateral: 12.4±1.3 mm, contralateral: 12.5±1.2 mm) (both P<0.001). Post-operative MRI showed that the transverse diameter of dural sac increased from 7.8±1.5 mm to 14.9±1.2 mm and the sagittal diameter increased from 9.2±1.8 mm to 14.8±2.1 mm, and the differences were statistically significant (both P<0.001). All 15 patients were followed up for 8.1±2.3 months (6-12 months). The VAS score decreased from 5.3±1.5 points to 0.6±0.2 points, the JOA score was enhanced from 14.5±1.8 points to 26.7±5.3 points, and the ODI decreased from 69.5%±13.8% to 12.9%±2.1% (all P<0.05). No lumbar instability or scoliosis was found.

Minimally invasive percutaneous microsurgical decompression via contralateral approach is effective in the treatment of lateral lumbar spinal stenosis with small lamina degeneration, which is beneficial for protection of bilateral facet joints to the greatest extent without affecting post-operative lumbar stability or mobility.

The clinical data of 6 patients with spontaneous intraspinal epidural hemorrhage admitted to the Department of Neurosurgery of Jingmen First People's Hospital (2 cases) and the Department of Neurosurgery of Union Hospital affiliated to Fujian Medical University (4 cases) from January 2019 to January 2022 were retrospectively analyzed. Four patients were treated with hematoma evacuation and laminoplasty by median approach, and one patient was treated with spinal canal decompression and hematoma evacuation under percutaneous microchannel microscope by paramedian approach; The postoperative MRI of the spine of 5 patients showed that the hematoma was cleared and the spinal canal was decompressed adequately, and there were no postoperative complications. The other patient was treated only conservatively, and the hematoma was absorbed and the neurological function was completely recovered after operation. At 6-month follow-up, neurological function was classified as E in 4 cases and D in 2 cases.

To explore the clinical features and surgical outcomes of low-grade epilepsy-associated neuroepithelial tumors (LEATs) in children.

A retrospective study was conducted in a single-center cohort of 46 child patients with LEATs who received surgery at the Department of Neurosurgery, Children′s Hospital Affiliated to Capital Institute of Pediatrics from December 2016 to January 2021. The clinical features and surgical outcomes of those children were analyzed, and the differences in some clinical data and surgical outcomes were analyzed between patients with tumors located in the temporal lobe and those with tumors in the extratemporal lobe and between patients with non-focal (generalized or diffusive) epileptic discharges and those with focal epileptic discharges.

Among the 46 cases, 34 cases (73.9%) had lesions in the temporal lobe and 12 cases(26.1%) had lesions in the extratemporal lobe; 26 cases (56.5%) had focal epileptic discharges and 20 cases (43.5%) had non-focal epileptic discharges. The pathologic findings showed gangliogliomas in 34 cases (73.9%). At the 3-month follow-up, all generalized or diffusive epileptic discharges disappeared. With a median follow-up of 35 (12-60) months, no tumor recurrence was found in the children at the last follow-up. In terms of seizures, 42 cases (91.3%) had the outcome of Engel class Ⅰ, 2 (4.3%) reached Engel class Ⅱ, and 2 (4.3%) reached Engel class Ⅳ. There were no significant differences in the age, electroencephalogram (EEG) pattern or postoperative Engel class between the temporal lobe group and extratemporal lobe group(all P>0.05). The proportion of stereoelectroencephalogram (SEEG) evaluation in patients with tumors located in the extratemporal lobe was higher than that in patients with tumors located in the temporal lobe [4/12 vs. 1/34 (2.9%)], and the difference was statistically significant (P=0.018). The proportion of young children (0-6 years old) in patients with non-focal discharges was higher than that in patients with focal discharges [80.0% (16/20) vs. 50.0% (13/26)] (P=0.037). However, there was no significant difference in Engel grading between patients with the two EEG patterns (P=0.422).

LEATsare mostly located in the temporal lobe. There are various pathological types, and the most common type is ganglioglioma. The proportion of patients with generalized or diffusive discharges on EEG is higher in young children. The prognosis seems good. There is no significant correlation between the outcome of epilepsy surgery and lesion location as well as EEG pattern.

To compare the clinical characteristics and treatment effects of patients with acute intracranial vertebral artery occlusion complicated with underlying intracranial atherosclerotic disease (ICAD-AIVAO) with and without basilar artery embolism.

We prospectively included ICAD-AIVAO patients who underwent emergency endovascular treatment within 24 hours from the onset at the Department of Cerebrovascular Diseases, Henan Provincial People′s Hospital from February 2017 to June 2021 and collected their clinical, imaging, treatment, as well as follow-up data. All patients with AIVAO were caused by in situ atherosclerotic thrombosis (ISAT). The patients were divided into the ISAT group and the ISAT with basilar artery embolism group according to whether there was artery-to-artery embolism involving the basilar artery. The baseline data, treatment and outcomes of the two groups were compared.

A total of 52 patients were enrolled. Males accounted for 90.4% (47/52), and progressive onset accounted for 57.7% (30/52). Compared with the ISAT group (32 cases), the ISAT with basilar artery embolism group (20 cases) had lower preoperative DWI-based posterior circulation Alberta stroke program early computed tomography score (DWI-pc-ASPECTS) and basilar artery on computed tomography angiography (BATMAN) score, higher pons midbrain index (PMI), and higher incidence of brainstem infarction and midbrain infarction (all P<0.05). The number of mechanical thrombectomy in the ISAT with basilar artery embolism group was higher than that in the ISAT group [M (Q₁, Q₃): 2 (1, 2) vs. 1 (0, 2), P=0.030]. The complete reperfusion rate in the ISAT with basilar artery embolism group was higher than that in the ISAT group [75.0% (15/20) vs. 46.9% (15/32), P=0.046]. However, there was no significant difference in the successful reperfusion rate, 90-day functional independence rate, 90-day good outcome rate, and 90-day mortality between the two groups (all P>0.05). During perioperative period, there was no significant difference in the dissection, embolic escape, and sICH (symptomatic intracranial hemorrhage) within 7 days after operation between the two groups (all P>0.05).

Compared with those without basilar artery embolism, the patients of ICAD-AIVAO with basilar artery embolism have a higher rate of brainstem infarction, more times of mechanical thrombectomy during operation, and a higher rate of complete reperfusion, while there is no significant difference in perioperative complications and outcomes between the two groups.

To compare and analyze the application advantages of one-time separation of musculocutaneous flap in frontotemporal cranioplasty.

The clinical data of 242 patients who underwent frontotemporal cranioplasty at the Neurosurgery Department of the Second Affiliated Hospital of Jiaxing University from January 2015 to December 2020 were retrospectively analyzed. Among them, 75 cases (31.0%) underwent one-time musculocutaneous flap separation (experimental group), and 167 cases (69.0%) were treated with conventional surgery (conventional group). The operation time, intraoperative dural suspension and meningeal damage rate, postoperative drainage volume, eyelid swelling, subcutaneous effusion, facial nerve injury, epileptic seizure, incision infection, incidence of hydrocephalus and postoperative hospital stay were compared between the two groups.

Compared with conventional group, the experimental group had lower postoperative drainage volume (184.1±45.1 ml vs. 254.3±52.3 ml), lower rates of eyelid swelling [9.3% (7/75) vs. 92.2% (154/167)] and subcutaneous effusion [20.0% (15/75) vs. 34.1% (57/167)] (all P<0.05). There was no facial nerve injury in the experimental group after surgery, which was reported with the rate of 5.4% (9/167) in the conventional group, and the difference was significant (P<0.05). However, there was no significant difference between the two groups in the length of operation, the rate of meningeal damage or dural suspension during operation, postoperative hospital stay or the incidence of incision infection (all P>0.05). Postoperative follow-up lasted for 3 months to 2.5 years, with a median of 1.2 years. There was no significant difference in the incidence of epileptic seizure or hydrocephalus between the two groups (both P>0.05).

Application of the technique of one-time separation of musculocutaneous flap in frontotemporal cranioplasty can reduce postoperative drainage volume and the risks of eyelid swelling, subcutaneous effusion and facial nerve injury.

From March 2016 to November 2021, 7 pregnant patients with intracranial arteriovenous malformation (AVM) were diagnosed and treated in multiple departments of Beijing Tiantan Hospital affiliated to Capital Medical University. All 7 patients developed the disease after 14 weeks of pregnancy, including 5 cases in the second trimester and 2 cases in the third trimester. Among the 5 patients with onset in the second trimester of pregnancy, 4 patients underwent craniotomy during pregnancy, and the fetus developed normally after operation, and all healthy fetuses were delivered by cesarean section after full term pregnancy; Another patient was treated conservatively until 33⁺Weeks, the fetus was delivered by cesarean section, and gamma knife was performed for AVM 43 days postpartum. Two patients who were near term pregnancy at the onset of the disease were treated by cesarean section first, followed by conservative treatment in one case and craniotomy in one case. Among the 7 patients, 5 patients underwent craniotomy had complete resection of the malformed vascular mass, and the score of Barthel Index (BI) scale was 50-75 at the time of discharge; The other 2 patients had a BI scale of 100 points. A total of 7 newborns were delivered by surgery, and the Apgar score of newborns at 1 min and 5 min at the time of delivery was 10 points.

To study the expression levels and biology function of Delta-like homolog 1 (DLK1) in pituitary adenoma cell lines.

Pituitary adenoma cell lines including ATT20, GH3 and MMQ were cultured ex vivo and cells were divided into experimental groups (anti-DLK1 antibody: 1 μg/ml and 5 μg/ml ) and control group (equal volume of dimethylsulphoxide) for 24 h, 48 h and 72 h. Cell lineages and DLK expression levels of ATT20, GH3 and MMQ were validated by Western blot; and cell proliferation was assessed using cell viability; and enzyme linked immunosorbent assay (ELISA) was used to measure the hormone secretion [GH3 cell: growth hormone (GH) and insulin-like growth factor 1 (IGF-1), MMQ: prolactin (PRL), ATT20 cell: adrenocorticotrophic hormone (ACTH)]; and immunofluorescence and Western blot were used to measure the levels of POU domain transcription factor 1 (POU1F1)-encoded protein, PIT1, in GH3 cells after anti-DLK1 antibody treatment.

Western blotting experiment verified that GH3 cell line and MMQ cell line were originally in the POU1F1 lineage and DLK1 was highly expressed, and ATT20 cell line was originally in the T-Box Transcription Factor 19 (TBX19) lineage and DLK1 was poorly expressed. After 48 h co-culturing with anti-DLK1 antibody, only the cell viability of GH3 experimental group was higher compared with control group (P=0.017); after 72 h co-culturing, the cell viability of GH3 experimental groups (P<0.01) and MMQ experimental group (5 μg/ml ) were higher compared with controls (P=0.041); and there was no statistical difference among ATT20 experimental groups and control in any timepoint (all P>0.05). After 24 h, 48 h and 72 h co-culturing with anti-DLK1 antibody, the GH level in cell culture supernatants of control GH3 cell was 8.8±0.6 ng/ml, 10.4±0.8 ng/ml and 13.2±0.9 ng/ml respectively, and that in the experimental group (5 μg/ml) was 6.7±0.7 ng/ml, 6.1±0.4 ng/ml and 4.7±0.4 ng/ml respectively, and the differences between control and experimental groups were significant at all 3 timepoints (all P<0.001). After 24 h, 48 h and 72 h co-culturing, the IGF-1 level in cell culture supernatants of control GH3 cell was 12.5±0.7 ng/ml, 14.6±1.0 ng/ml and 15.9±1.1 ng/ml respectively, and that in the experimental group (5 μg/ml) after 24 h, 48 h and 72 h DLK1 treatment was 10.9±0.7 ng/ml, 11.8±0.8 ng/ml and 8.3±0.7 ng/ml respectively, and the differences between control and experimental groups were significant after both 48 h and 72 h timepoints (both P<0.05). Immunofluorescence experiment and western blot experiment showed that the levels of both DLK1 and PIT1 in experimental GH3 cells were lower than those in control GH3 cells after anti-DLK1 antibody treatment (P<0.01).

DLK protein is highly expressed in POU1F1 lineage pituitary adenoma cell lines, and poorly expressed in TBX19 lineage pituitary adenoma cell line. Anti-DLK1 antibody is able to inhibit the secretion of GH and IGF-1 in POU1F1 lineage GH3 cell line and promote the cell proliferation. POU1F1 may be the downstream molecular target of DLK1.

To investigate the miRNAs-mediated malignant transformation of macro-phages (Mφ) in the glioma tumor microenvironment (TME) and to explore its mechanisms.

Bone marrow-derived cells (BMDCs) from green fluorescent protein (GFP) positive mice were obtained, and the BMDCs further directed differentiation into Mφ-GFP. Glioma stem cells(GSCs) expressing red fluorescent protein (GSCs-RFP) were co-cultured with Mφ-GFP in vitro. The monoclonal GFP⁺ cells with indefinite proliferation potential were referred to as malignantly transformed macrophages (t-Mφ). The differential expression profiles of miRNAs between t-Mφ and normal Mφ were obtained from the miRNAs microarrays. The expression profiles of the target miRNAs were compared in different WHO grades of glioma tissues from the Chinese Glioma Genome Atlas (CGGA) database between 10 glioma tissues and adjacent normal tissues and between t-Mφ and normal Mφ. We also analyzed the correlation between the target miRNAs expression levels and patients′ survival time. Flow cytometry, quantitative real-time PCR(qRT-PCR), Western blot, and luciferase report assay were used to analyze the underlying molecular mechanism of target miRNA regulating the malignant transformation of Mφ in TME.

GFP⁺ cells with indefinite proliferation potential were successfully isolated from the dual-color fluorescence co-culture system and expressed Mφ markers F4/80 and CD11b. Differential expression profiles of miRNAs and qRT-PCR showed that the expression of miR-223-3p was significantly elevated in the t-Mφ compared with normal Mφ. The analysis of CGGA revealed that miR-223-3p expression levels were significantly higher in glioblastomas (WHO grade 4) than those in low-grade gliomas (WHO grade 2/3) (P<0.001). Survival analysis indicated that patients with high expression of miR-223-3p had worse overall survival than those with low expression (P<0.01). Down-regulation of miR-223-3p promoted t-Mφ apoptosis (P<0.01). Bioinformatics analysis revealed a potential binding site for miRNA-223-3p in the 3′-UTR region of receptor-interacting serine/threonine-protein kinase (RIPK3). The results of luciferase assay showed that the fluorescence intensity was significantly lower in t-Mφ cells co-transfected with miR-223-3p mimics and RIPK3-WT compared with that of cells co-transfected with miR-223-3p mimics control and RIPK3-WT (P<0.01). The experiments of qRT-PCR and Western blot confirmed that the expression level of RIPK3 was significantly higher in miR-223-3p down-regulated t-Mφ (P<0.01), while that in miR-223-3p overexpressed t-Mφ was significantly lower compared with control group (P<0.05). Additionally, the proportion of apoptotic cells in t-Mφ was significantly lower in the miR-223-3p inhibitor/RIPK3 inhibitor group than in the miR-223-3p inhibitor group (P<0.01).

GSCs induce the malignant transformation of Mφ in TME, and miR-223-3p could target RIPK3 and inhibit the expression of RIPK3 in t-Mφ, which in turn inhibits the apoptosis in t-Mφ.

Developmental defect of the neural tube junction (JNTD) is a rare congenital malformation of the central nervous system, mainly manifested by discontinuity of spinal cord morphology and function. Searching the literature at home and abroad only revealed case reports. This article reports a patient with JNTD with pilar sinus, who underwent pilar sinus resection and tethered cord release. JNTD was confirmed during the operation, and was followed up for 3 months. There were no surgery-related complications and new neurological symptoms.

Vertebral arteriovenous fistula is mainly caused by trauma, etc. Vertebral arteriovenous fistula associated with type I neurofibromatosis is very rare. In December 2019, the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University treated a patient with type I neurofibromatosis complicated with spontaneous vertebral arteriovenous fistula, and the fistula was completely embolized by intravascular double catheter technique. The patient's symptoms improved significantly after operation, and the cervical MRI reexamination after 6 months showed no recurrence.

Indocyanine green (ICG), as a near-infrared fluorescent imaging agent widely used in human body, was initially used in the function evaluation of heart, liver and other organs and clinical diagnosis of related diseases because it can quickly bind to plasma protein in human body and be completely metabolized and excreted from the body. At present, due to its enhanced permeability and retention effects in tumor tissues, it is used to assist in surgical resection of tumors. Intraoperative ICG tumor imaging supported by new technologies has also become the focus of many clinical research institutes. At present, there are relatively few clinical studies on the application of ICG in glioma, especially highly aggressive glioblastoma, and the prospect of clinical application is relatively unclear. In this paper, the clinical application of ICG in glioma is reviewed, in order to be helpful to clinic.

Meningiomas are one of the most common intracranial tumors, accounting for about 1/3 of all intracranial tumors. With the popularization of imaging devices, small meningiomas (diameter<3.0 cm), the detection rate is increasingly high, and it is of great practical significance to focus on the treatment of small meningiomas. At present, there are no clear standards and guidelines for the clinical treatment of small meningiomas, which need to be considered comprehensively according to the patient's clinical symptoms, age, tumor nature, size, location, degree of edema, and patient's willingness to treat. There are different views on whether small meningiomas require treatment and the choice of treatment. This article reviews the treatment status and research progress of small meningioma, in order to provide reference for the clinical diagnosis and treatment of small meningioma.

Trans-radial approach refers to the method of puncturing and catheterization with the radial artery as the target vessel and establishing intravascular access. In recent years, with the rapid development of endovascular diagnosis and treatment technology, transradial approach has shown good feasibility and safety in neurointerventional diagnosis and treatment. It is not only used in diagnostic whole brain angiography, but also widely used in endovascular treatment of various neurological diseases. This article mainly reviews the research progress of transradial approach in neurointerventional diagnosis and treatment.

Intracranial aneurysm is a common cerebrovascular disease, such as ruptured hemorrhage can lead to high mortality and disability rates. Therefore, it is crucial to develop predictive models that can accurately assess the risk of instability of unruptured intracranial aneurysms. With the gradual application of artificial intelligence technology in the field of neurological diseases, it is possible to predict the instability risk of intracranial aneurysms using this technology. This article aims to introduce the current status and prospects of using artificial intelligence technology to predict the risk of instability in unruptured intracranial aneurysms.

The blood flow guiding device reconstructs the tumor-bearing artery through the principle of hemodynamics, forms new endothelium at the neck of the aneurysm and occludes the aneurysm, which is an innovation in the concept and technology of endovascular treatment of intracranial arteries. Currently, there are 7 different types of blood flow directing devices. In this paper, the structural characteristics of these 7 devices and their application in the treatment of intracranial aneurysms are reviewed, so as to provide reference for the selection of endovascular treatment materials for intracranial aneurysms.