Volume 39 · Issue 04 · 2023

Meningiomas are the most common primary tumors of the central nervous system (CNS) with diverse pathological types and complex clinical manifestations^[1]。 The 2021 World Health Organization (WHO) CNS Tumor Classification classifies meningiomas into WHO grades 1 to 3, including 15 pathological subtypes^[2]Among them, about 80% are WHO grade 1 meningiomas, and about 20% are WHO grade 2-3 meningiomas^[1]。 Most patients with low-grade meningioma (WHO grade 1) can achieve a good clinical prognosis through surgery and/or radiation therapy. However, some low-grade and high-grade meningiomas (WHO grade 2~3) with progressive tendency still face the problems of low total resection rate, high recurrence rate and disability rate^[3,4]。 In recent years, more and more studies have found that the molecular pathological characteristics of meningioma from gene to protein level are closely related to its pathological grade and clinical prognosis^[1,5,6,7,8]； In addition, traditional pathological grading and typing based on histomorphology alone as the primary criterion is no longer sufficient to accurately predict the clinical prognosis of all patients with meningioma^[1,5,6,7,8]。 Therefore, it is particularly important to apply molecular typing to the diagnosis, treatment, disease monitoring and decision-making of follow-up treatment plan of patients with meningioma. Based on the traditional pathological classification of meningioma, this consensus integrates key molecular biological markers that can refine the diagnosis and classification of meningioma, aiming to further improve the diagnosis and treatment level of meningioma and improve the prognosis of patients.

Led by China Anti-Epilepsy Association, in conjunction with experts from the Craniocerebral Trauma Group of Neurosurgery Branch of Chinese Medical Association, the Neurological Injury Group of Traumatology Branch of Chinese Medical Association, the Glioma Professional Committee of Chinese Anti-Cancer Association, and the Neurological Oncology Professional Committee of Chinese Neuroscience Society Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery was published in the journal Therapeutic Advances in Neurological Disorder in August 2022. This guide systematically summarizes the clinical work experience of domestic and foreign scholars, especially Chinese scholars, for the first time, reflects the research results of multidisciplinary experts, and provides the first relevant clinical guide for the application of anti-seizure drugs in perioperative period of craniocerebral surgery. The guidelines cover the formulation methods, scope of application, application of anti-seizure drugs during perioperative period of craniocerebral surgery under different circumstances, emergency management of seizures and recommendations, etc. In addition, the guidelines explain important epilepsy-related concepts, characteristics of anti-seizure drugs, common side effects and treatment methods, etc., which are highly practical. This paper explains the relevant points.

To investigate the clinical efficacy of adjuvant radiotherapy after surgical resection of extraventricular neurocytoma (EVNs).

A retrospective study was conducted on the clinical data of 10 EVN patients (accounting for 6.8% of intraventricular and extraventricular neurocytomas treated in the same period) who underwent tumor resection with or without postoperative adjuvant radiotherapy (RT) from January 2001 to December 2020. Among them, 5 cases were admitted to the Department of Neurosurgery and Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, and 5 cases were admitted to the Department of Neurosurgery and Department of Radiation Oncology of Xuanwu Hospital, Capital Medical University. The tumor was located in the sellar region in 2 cases, in the frontal lobe in 2 cases, in the thalamus in 3 cases, in the parietal lobe in 1 case and in the spinal cord in 2 cases. Six patients underwent three-dimensional conformal radiotherapy or adjuvant intensity-modulated radiation therapy with a median dose of 54 Gy (range: 50.4-58.0 Gy). Follow-up was performed postoperatively by out-patient clinic or telephone. Kaplan-Meier survival analysis was used to evaluate the survival of patients, and tumor recurrence was determined by imaging follow-up.

Except 1 case undergoing biopsy, the remaining 9 cases underwent tumor resection, including gross total resection in 3 cases, subtotal resection in 3 cases, and partial resection in 3 cases. All patients were followed up for a median of 69.5 months (range: 16-142 months). Among the 10 patients, a total of 3 relapsed, 2 of which were located in the cervical spinal cord and included 1 patient who underwent biopsy and 1 patient who underwent total resection. The former died of tumor recurrence 16 months after the operation; the latter underwent operation and radiotherapy after recurrence and still survived with tumor at the last follow-up. One patient developed orthotopic recurrence in the sellar region at 7 months post partial resection, underwent surgical resection and radiotherapy, and remained alive with residual tumor at the last follow-up. None of the 5 patients who received incomplete resection (subtotal resection or partial resection) plus adjuvant radiotherapy had a recurrence. Among the 3 patients who received total resection, 1 of the 2 patients who received no adjuvant radiotherapy had a recurrence, while the patient who received adjuvant radiotherapy had no recurrence. The 5-year and 10-year overall survival rates of the 10 patients were both 90%, and the 5-year and 10-year progression-free survival rates were 80% and 60%, respectively.

Preliminary studies suggest that adjuvant radiotherapy after incomplete resection in patients with EVN may achieve progression-free survival comparable to total resection.

To investigate the efficacy of surgical therapy of acoustic neuromas after failed gamma knife treatment.

The clinical data of 23 patients with acoustic neuromas treated in the Department of Neurosurgery, Sanbo Brain Hospital of Capital Medical University from January 2010 to December 2021 were retrospectively analyzed. Twenty-three patients who were previously treated with gamma knife (experimental group) underwent surgical resection because of tumor progression. Functional nerve preservation was performed during the operation. Another 23 patients who had not been treated with gamma knife were defined as the control group with matching sex composition ratio, age, tumor size, texture and location. The patients were clinically followed up and the facial nerve function was evaluated by House-Brackmann (HB) grading system. The recurrence or progression of the tumor was evaluated by imaging follow-up. The baseline data, degree of surgical resection, postoperative complications, outcome of facial nerve function and recurrence were compared between the two groups.

The degree of adhesion between facial nerve and tumor in the experimental group was greater than that in the control group (P<0.001). The total tumor resection rate in the experimental group (21.7%, 5/23) was lower than that in the control group (73.9%, 17/23)(χ²=12.54, P<0.001). The anatomic preservation rate of facial nerve was 100% (23/23) in both groups. Postoperative HB gradeⅠ-Ⅱ in the experimental group accounted for 73.9% (17/23), which was not significantly different from that in the control group (91.3%, 21/23) (P=0.189). The median follow-up time was 57 months (range: 12-133 months) in the experimental group and 52 months (range: 14-120 months) in the control group. There was no tumor recurrence or progression in the two groups. At the last follow-up, the patients with HB grade Ⅰ-Ⅱ in the experimental group and control group accounted for 82.6% (19/23) and 95.7% (22/23) respectively, and there was no significant difference between the two groups (P=0.412).

The degree of surgical resection of advanced acoustic neuromas after failed gamma knife treatment is relatively low. Functional nerve preservation resection can optimize the results of facial nerve function and doesn′t increase the risk of tumor recurrence.

To explore the role of laser confocal micro-Raman spectroscopy combined with different analytical methods in identification of the secretory types of pituitary adenomas (PAs).

The tumor samples of 20 PA patients surgically resected in the Department of Neurosurgery of Chongqing General Hospital from December 2020 to April 2022 were collected. Postsurgical pathological examinations revealed that there were 5 cases of gonadotropin cell adenoma, 5 cases of growth hormone (GH) cell adenoma, 5 cases of zero-cell adenoma, 4 cases of prolactin (PRL) cell adenoma, and 1 case of adrenocorticotropin hormone (ACTH) cell adenoma. Laser confocal micro-Raman spectroscopy was applied to detect the Raman spectra of different secretory types of PAs. We selected 4/5 of the obtained spectral data as the training set and 1/5 of the spectral data as the test set. The principal component analysis (PCA) combined with linear discriminant analysis (LDA, PCA-LDA) or quadratic discriminant analysis (QDA, PCA-QDA) was used to analyze the training set spectral data and construct qualitative discriminant models. The accuracy of the model based on the test set was analyzed to determine the types of PA secretion.

A total of 2 000 Raman spectra were obtained, including 500 for gonadotropin cell adenomas, 500 for GH cell adenomas, 500 for zero-cell adenomas, 400 for PRL cell adenomas, and 100 for ACTH cell adenomas. The spectra of PRL cell adenoma showed significant peak shifts at 1 064, 1 128, and 1 342 cm^-1, the spectra of GH cell adenoma showed significant peak shifts at 1 004 cm^-1, the spectra of gonadotropin cell adenoma showed significant peak shifts at 854 and 1 660 cm^-1, the spectra of ACTH cell adenoma showed significant peak shifts at 854, 1 128, and 1 451 cm^-1, and the spectra of zero-cell adenoma showed significant peak shifts at 1 004 and 1 660 cm^-1. The PCA-LDA and PCA-QDA qualitative discrimination models were constructed after analysis of the training set of Raman spectral data. When combining the first 8 principal components of the spectral data, the accuracy of the PCA-LDA test set in determination of the classification of pituitary adenomas was 76.61%, and the accuracy of PCA-QDA was 96.64%.

The Raman spectra of PAs of different hormone types are different. Laser confocal micro-Raman spectroscopy combined with PCA-QDA qualitative discrimination model can effectively distinguish different hormone types of PAs.

To evaluate the application value of preoperative three dimensional (3D) tomographic reconstruction technology in surgery of thoracic and lumbar dumbbell-shaped tumors.

The clinical data of 24 patients with thoracic or lumbar dumbbell-shaped tumors admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2017 to December 2021 were analyzed retrospectively. Besides MRI examination, enhanced CT scanning of thoracic or lumbar spine was performed for all patients and the primary imaging data were input into a commercially available 3D medical imaging reconstruction system for 3D reconstruction. Based on the stereoscopic images, surgical plans were determined for guiding tumor resection. To evaluate the efficacy of surgery, CT and MRI examination were performed one week and three months after surgery. Outpatient follow-up was applied to assess symptom relief. Neurological function was evaluated by using McCormick scale, and pain perception was assessed based on the visual analogue scale (VAS).

All tumors (100.0%) were completely removed in one-stage operation, with a mean operation time of 140±48 min (range: 80-215 min) and a mean blood loss of 270±120 ml (range: 50-600 ml). The hospital stay was 4-11 days (mean: 7.5±2.1 days). Pathological results revealed 19 cases of schwannoma, 2 cases of gangliocytoma, 2 cases of neurofibroma and 1 case of neuroectodermal tumor. All patients showed different degrees of relief of preoperative symptoms. Postoperative complications occurred in 3 cases, including 2 cases (8.3%) of pneumothorax, 1 case (4.2%) of cerebrospinal fluid leakage and wound infection, and no death cases. All 24 patients were followed up for 3-40 months (mean: 15.2±6.5 months). At the last follow-up, the VAS score of 24 patients decreased from 3.0±2.0 points to 1.1±1.0 points after surgery (t=4.05, P=0.001). The patients′ McCormick grades improved compared with preoperative grades (Z=-4.60, P<0.001). During the follow-up, no spinal instability was found. The CT images at 3 months post operation showed no tumor recurrence.

Preoperative 3D tomographic reconstruction is effective in guiding the choice of surgical strategies for complete resection of thoracic and lumbar dumbbell tumors and could help improve patients′ prognosis by providing clear and stereoscopic visual information.

To investigate the predictive value of intraoperative bulbocavernosus reflex (BCR) monitoring for bowel function outcomes of patients undergoing conus medullaris or cauda equina tumor surgery.

From September 2021 to March 2022, a total of 88 patients with conus medullaris or cauda equina tumors underwent surgery and intraoperative BCR monitoring in the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University and their clinical data were retrospectively analyzed. The reduction ratio of bilateral BCR amplitude during the operation was documented, and the side with higher reduction ratio of BCR amplitude (reflected by the ratio of change in amplitude) was selected as the evaluation index for intraoperative monitoring. According to the Neurogenic Bowel Dysfunction Score (NBDS), the patients were divided into good bowel function group (NBDS≤6 points) and poor bowel function group (NBDS>6 points). Univariate and multivariate logistic regression analyses were used to explore the influencing factors of bowel function outcome at 1 and 6 months after operation. Receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to determine the critical value of BCR and its predictive value.

Among the 88 patients, 84(95.5%) patients demonstrated effective BCR waveform during operation, and the BCR amplitude change ratio [M (Q₁, Q₃)] was 16.7%(3.7%, 51.7%). Among them, 58 cases (69.0%) received total tumor resection, and 26 cases (31.0%) had incomplete tumor resection. The good bowel function rate was 84.5%(71/84) and 86.9%(73/84) at 1 month and 6 months after operation respectively. The results of univariate analysis showed that only the degree of tumor resection and the change rate of BCR amplitude had statistically significant effects on the outcome of bowel function at 1 month and 6 months after operation (both P<0.05). Multivariate logistic regression analysis showed that the change ratio of BCR amplitude was the main influencing factor of bowel function outcome at 1 month and 6 months after operation (OR=1.12, 95%CI: 1.04-1.21; OR=1.10, 95%CI: 1.03-1.19; both P<0.05). The critical values of BCR amplitude change ratio at 1 month and 6 months after operation to predict the outcome of bowel function were 72.7% and 86.9% respectively, the sensitivity was 94.5% and 92.4% respectively, the specificity was 95.1% and 93.7% respectively, and the AUC was 0.97, 0.95 respectively.

Intraoperative BCR monitoring is helpful to predict the postoperative bowel function outcome in patients with conus medullaris or cauda equina tumors, and a decrease of >87% in BCR amplitude can be used as an intraoperative early warning standard for predicting poor bowel function in short- and medium-term follow-up.

To investigate the clinical and pathological features of central nervous system (CNS) melanocytic tumors.

A retrospective analysis was conducted on the clinical data of 6 patients with CNS melanocytic tumors admitted to the Department of Neurosurgery of Beijing Ditan Hospital, Capital Medical University from June 2018 to November 2021. The general information, past medical history, clinical manifestations, imaging data and postoperative pathological results of the patients were collected. Outpatient, telephone and imaging were used for follow-up, and the content of follow-up included postoperative adjuvant treatment, improvement of symptoms, tumor recurrence and metastasis, etc.

The clinical manifestations were headache in 4 cases, lower limbs pain and numbness in 1 case, facial pain in 1 case and memory decline in 1 case. Imaging examination showed that all 6 cases had single tumors, including 1 case in the spinal canal at L₂ vertebral level and 5 cases located at the brain. Total resection was performed in 4 cases, subtotal resection in 1 case, and partial resection in 1 case. Based on the medical history and pathological examination results, the patients were diagnosed as meningeal melanoma cell tumor in 2 cases (melanotic pattern), primary melanoma in 2 cases (amelanotic pattern) and metastatic melanoma in 2 cases (hematoma pattern). HE staining results showed that different amounts of melanin particles were observed in the tumor tissues of all 6 cases. Immunohistochemical staining showed HMB-45 (+ ) in 6 cases, S-100(+ ) in 4 cases, Melan-A (+ ) in 6 cases, VIM (+ ) in 3/3 and EMA (-) in 3/3 cases. The Ki-67 proliferation index was ≤30% in the 2 melanoma cell tumors and 40%-80% in the other 4 melanoma tissues. Follow-up time ranged from 2.9 to 44.2 months. Postoperative adjuvant therapy was not received in 2 cases, radiotherapy and chemotherapy were received in 2 cases, chemotherapy alone in 1 case, and immunotherapy in 1 case. At the last follow-up, there were 2 cases of relapse, 2 cases of metastasis and 2 cases of death (diagnosed as melanoma, survival time was 2.9 and 21.4 months, respectively).

Preliminary findings have shown that the melanotic imaging pattern is more likely to be benign melanoma. Surgical excision combined with postoperative adjuvant therapy can improve the prognosis, while the overall prognosis seems poor.

To evaluate the clinical efficacy and risk factors of ischemic complications following flow diverter (FD) treatment of middle cerebral artery (MCA) aneurysms.

A retrospective analysis was performed on the clinical and imaging data of 86 patients with MCA aneurysms treated with FD from April 2016 to December 2021 in the Department of Interventional Neurology of the First Affiliated Hospital of Zhengzhou University. Clinical and imaging follow-up was conducted at 3, 6 and 12 months after surgery. Clinical outcomes were assessed using the modified Rankin scale (mRS). Aneurysm occlusion was assessed using O′Kelly-Marotta (OKM) grading criteria. Surgery-related complications were observed during perioperative and follow-up periods, and patients were divided into group of ischemic complications and that of non-ischemic complications according to the presence or absence of ischemic complications during the perioperative period. Clinical data from the two groups were compared. Univariate logistic regression analysis were used to determine the influencing factors of ischemic complications in the perioperative period of FD treatment of MCA aneurysm.

A total of 90 FDs were successfully placed in 86 patients (90 aneurysms). The incidence of perioperative complications was 12.8% (11/86), including 9 cases of ischemic cerebrovascular disease, 1 case of subarachnoid hemorrhage, and 1 case of other complication. Eighty-two patients received clinical or telephone follow-up, with a median follow-up time of 8 months (3-40 months). The follow-up complication rate was 4.9% (4/82), all of which were ischemic complications. At the last follow-up, the mRS score was 0 in 75 cases, 1 in 5 cases and 3 in 2 cases. Fifty-three patients underwent digital subtraction angiography follow-up, with a median time of 7 months (2-28 months). The complete occlusion rate for MCA aneurysms at last follow-up was 67.9% (36/53). There was significant difference in perioperative antiplatelet regimen between the group of ischemic complications (9 cases) and that of non-ischemic complications (77 cases) (χ²=9.33, P=0.004). The results of univariate logistic regression analysis showed that compared with aspirin + clopidogrel, the regimens of aspirin + ticagrelor and aspirin + tirofiban + clopidogrel (or ticagrelor) had a protective effect on the occurrence of perioperative ischemic complications (both OR=0.09, both P<0.05).

The clinical outcome of MCA aneurysms treated by FD seems relatively good, and antiplatelet regimen may be a factor influencing the development of ischemic complications in the perioperative period.

To preliminarily discuss the feasibility and clinical efficacy of side-to-side anastomosis in superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in adults with moyamoya disease (MMD).

A retrospective analysis was conducted on the clinical data of 46 adult patients with MMD who were treated by side-to-side anastomotic STA-MCA bypass combined with encephalo-duro-myo-synangiosis from February to May 2022 in the Department of Neurosurgery of Zhongnan Hospital of Wuhan University. All patients underwent preoperative digital subtraction angiography (DSA), MRI, and single photon emission computed tomography (SPECT) examinations to evaluate cerebral blood perfusion and confirm bypass sites. SPECT examinations at 1-2 days post operation were performed to evaluate the improvement of cerebral blood flow (CBF). Magnetic resonance angiography (MRA) or DSA examination was performed to evaluate the patency of bypass vessels. At 3 months post operation, DSA examination was performed and the outcome of revascularization was evaluated using Matsushima grading system. The modified Rankin Scale (mRS) was used to evaluate the patients′ clinical outcomes.

The operations of 46 patients were all successfully completed, and perioperative complications occurred in 4 cases, among which the incidences of hyperperfusion syndrome and cerebral infarction were 6.5% (3/46) and 2.2% (1/46) respectively. At 1 day post operation, the SPECT results of all patients showed that postoperative/preoperative relative CBF value at the bypass site was 1.20±0.14. MRA or DSA follow-up after operation showed that the patency rate of bypass vessels was 97.8% (45/46). Thirty-four patients were followed up by DSA at 3 months post operation, and the results showed that there were 16, 12 and 6 patients with Matsushima grade A, B and C respectively. All patients were followed up clinically. The number of patients with mRS score of 0 increased from 8 before operation to 38, that of patients with mRS score of 1 decreased from 37 before operation to 6, that of patients with mRS score of 2 increased from 1 before operation to 2, and 95.7% (44/46) of the patients demonstrated improvement of neurological function.

Preliminary results have shown that the side-to-side anastomotic STA-MCA bypass surgery can effectively treat MMD in adults with a low incidence of perioperative complications.

To explore the treatment strategy and therapeutic effect of postoperative implant (titanium mesh or polyetheretherketone, PEEK) exposure in patients with craniocerebral trauma who underwent cranioplasty for skull defect after craniectomy.

A retrospective analysis was conducted on the clinical data of 25 patients with implant exposure after skull defect repair from May 2012 to October 2020 at the Department of Neurosurgery, the Second Affiliated Hospital of Nantong University (Nantong First People′s Hospital) (10 cases) and the Brain Injury Center, Renji Hospital, Shanghai Jiaotong University School of Medicine (15 cases). According to whether there was infection, exposure time, size, and shape of the patient′s exposed wound, an individual decision was made on whether to perform surgical treatment and whether to remove repair materials. If subcutaneous infection was present, the infected lesion should be aggressively debrided and the prosthetic material removed. The postoperative wound healing was used as the index of therapeutic effect. Patients were followed up on wound healing, appearance restoration, and quality of life at 1, 3, 6, and 12 months after discharge.

Among the 25 patients, 23 had titanium mesh exposure, 2 had PEEK exposure; 13 (52.0%) patients had implant exposure accompanied by wound infection. Two cases of locally infected titanium mesh repair patients were cured by non-surgical treatment, and the other 23 cases were treated by surgery. Among the surgical patients, 10 patients had the repair material preserved by the rotation flap, and 13 had the material removed. During the 12 months follow-up of 25 patients, 11 of the patients whose material was removed were repaired again; all patients healed well, and the quality of life was not affected.

Implant exposure after cranioplasty in patients with traumatic brain injury is often accompanied by wound infection. Non-surgical treatment can be considered for patients with only local wound infection. For patients without subcutaneous infection, a rotation flap can be selected to cover the wound and the original repair material is retained. For patients with subcutaneous infection, the repair material should be removed and long-term repair should be considered. After individualized treatment, the patient′s wound could heal well without affecting the quality of life.

To investigate the effect of lysophosphatidylcholine acyltransferase 1 (LPCAT1) on the tumor proliferation, invasion and apoptosis of human glioblastomas (GBMs) and to explore its mechanisms.

Based on the Chinese Glioma Genome Atlas (CGGA) database, the expression of LPCAT1 was analyzed among lower grade gliomas [LGG, World Health Organization(WHO) grade Ⅱ and Ⅲ] and GBMs. The expression of LPCAT1 was validated through Western blot (WB) in 4 LGG and 4 GBM tissue samples from patients undergoing surgical resection at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University. LPCAT1 was knocked down by siRNAs, and the transfected LN18 cells were divided into three experimental groups including negative control group, LPCAT1 si1 group and LPCAT1 si2 group. The knockdown efficiency of LPCAT1 siRNA was detected by real-time quantitative PCR (qPCR) and WB. The effects of LPCAT1 knockdown on tumor cell proliferation, invasion and apoptosis in three experimental groups were detected by cell counting Kit-8(CCK8) test, transwell assay and flow cytometry respectively. The effect of LPCAT1 knockdown on the expression of epidermal growth factor receptor (EGFR) and phosphorylation Tyr1068 of EGFR in the three experimental groups was also detected by qPCR and WB.

Based on the CGGA database analysis, LPCAT1 mRNA expression in GBMs was significantly higher than that in WHO grade Ⅱ and Ⅲ gliomas(both P<0.05). WB results based on clinical samples showed that the expression of LPCAT1 in GBM was significantly higher than that in LGG (1.167±0.123 vs. 0.561±0.081, t=4.13, P<0.001). The qPCR results showed that the gene expression level of LPCAT1 in LPCAT1 si1 and LPCAT1 si2 groups were significantly lower than that in negative control group (both P<0.001). WB results revealed the same results (both P<0.01). The results of CCK8 showed that the cell proliferation in LPCAT1 si1 and LPCAT1 si2 groups (absorbance value: 1.043±0.025 and 0.875±0.040 respectively) were significantly lower than that in negative control group (1.202±0.028) (both P<0.01). Transwell experiment showed that the number of migrated cells in LPCAT1 si1 and LPCAT1 si2 groups were significantly lower than that in negative control group (both P<0.001). Flow cytometry showed that the percentage of apoptotic cells in LPCAT1 si1 and LPCAT1 si2 groups (49.5%±0.3% and 38.7%±0.3% respectively) was significantly higher than that in negative control group (17.1%±0.1%) (both P<0.001). The qPCR results showed that the gene expression level of EGFR in LPCAT1 si1 and LPCAT1 si2 groups was significantly lower than that in negative control group (both P<0.001). WB results showed that the EGFR Tyr1068 phosphorylation level in LPCAT1 si1 and LPCAT1 si2 groups was significantly lower than that in negative control group (both P<0.05).

Preliminary study has shown that inhibition of LPCAT1 expression can reduce proliferation and invasion of GBM cells, and promote apoptosis of GBM cells, which might be mediated by decreasing the phosphorylation of EGFR.

To investigate the effect of hydrogen sulfide (H₂S) on hemin-induced ferroptosis in mouse hippocampal neurons.

HT-22 cells were divided into normal group and hemin injury group with different concentrations (50, 75, 100 and 125 μmol/L). The hemin injury group cells were injured by hemin for 24 h to establish the cell injury model. HT-22 cells were divided into hemin 75 μmol/L group and hemin 75 μmol/L + NaHS treatment group with different concentrations (50, 100 and 200 μmol/L). NaHS treatment group cells were treated with hemin and NaHS for 24 h. The cell viability was assessed by Cell Counting Kit-8 (CCK-8). The expression of glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11) was detected by Western blotting. Necrotic cell death was measured by Calcein-AM/propidium iodide (Calcein-AM/PI) staining. The 2′, 7′-dichlorodihydro-fluorescein diacetate (DCFH-DA) fluorescent probe was used to detect reactive oxygen species (ROS). Ultrastructural images were observed using a transmission electron microscope. Ferrous ion content was performed using the FerroOrange kit. Moreover, GPX4 was identified by immunofluorescence staining.

Both CCK-8 and Western blotting results indicated that the survival rate and the expression levels of SLC7A11 and GPX4 decreased in different hemin concentration groups and showed a downward trend with the increase of hemin concentration; the differences were statistically significant (all P<0.05). CCK-8 assay results indicated that the survival rate in hemin 75 μmol/L + NaHS (50, 100 and 200 μmol/L) groups was higher than that in hemin 75 μmol/L group. Calcein-AM/PI assay results indicated that the PI positive cells in hemin 75 μmol/L + NaHS 100 μmol/L group was less than that in hemin 75 μmol/L group. Both DCFH-DA and FerroOrange staining results indicated that the relative levels of ROS and Fe²⁺ in hemin 75 μmol/L + 100 μmol/L NaHS group were lower than those in hemin 75 μmol/L group. Both Western blotting and immunofluorescence staining indicated that hemin 75 μmol/L + 100 μmol/L NaHS group had significantly increased SCL7A11 and GPX4 level as compared with hemin 75 μmol/L group. The differences as above were all statistically significant (all P<0.05). Electron microscope investigation showed shrunken mitochondria and absence of mitochondria cristae in hemin 75 μmol/L group and obvious improvement of mitochondrial morphology in hemin 75 μmol/L + 100 μmol/L NaHS group.

H₂S treatment protects HT-22 mouse hippocampal neurons from hemin injury via decreasing oxidative stress, reducing iron accumulation, enhancing SLC7A11 and GPX4 level and inhibiting ferroptosis.

Deep brain electrical stimulation (DBS) is the main surgical method for the treatment of drug-refractory tremor, and the ventral intermediate nucleus of the thalamus (VIM) is the preferred target for surgery. In recent years, the posterior subthalamic nucleus (PSA) has also been gradually applied in clinical practice and is considered as a potential target. From June to October 2020, the Department of Neurosurgery of Kunming Sanbo Brain Hospital performed surgical treatment on 2 patients with tremor by bilateral single-electrode dual-target electrical stimulation, i.e. VIM combined with PSA-DBS. The postoperative effect was good, which confirmed the feasibility of the operation. Through program control, it was found that PSA was more ideal for tremor control.

There are few cases of frontal skin infection and sinus formation after craniocerebral trauma. In August 2021, a patient with frontal sinus abscess after craniocerebral trauma was admitted to the Department of Otolaryngology, Second Affiliated Hospital of Kunming Medical University. The patient's forehead infection was reduced after nasal endoscopy by Draf type Ⅱb surgery. After 9 months of reexamination, the forehead skin was not infected, the skin fistula was smaller than before, and the reexamination CT showed that the frontal sinus drainage was unobstructed.

Dural arteriovenous fistula (DAVF) is a type of intracranial vascular malformation that is rare in the pediatric population. DAVF in children progresses rapidly and is severely ill compared to adults. Therefore, early diagnosis and treatment may save the child's life. Endovascular embolization is currently the main treatment for DAVF. In March 2017, the Department of Neurosurgery of Liaocheng People's Hospital treated an infant with DAVF in the superior sagittal sinus area. Preoperative digital subtraction angiography showed bilateral blood supply from the posterior branch of the middle meningeal artery, and the superior sagittal sinus showed "lake-like" dilatation. Endovascular treatment was given, and it was cured by one-time embolization through the left middle meningeal artery approach. Bilateral subdural hematoma appeared after operation, and conservative treatment was given. After regular follow-up, the subdural hematoma of the child gradually absorbed, the superior sagittal sinus gradually shrank, the "lake-like" dilatation of the vein gradually disappeared, and the DAVF did not relapse. The child recovered well.

Convection enhanced drug delivery (CED) is a technique that enables drug delivery directly into the brain or tumor tissue without crossing the blood-brain barrier. At present, some clinical trials have been carried out internationally to treat patients with high-grade supratentorial glioma by CED infusion of different drugs, and certain curative effects have been observed in some patients. However, the application of CED equipment materials, drug selection and development, drug distribution and pharmacokinetics are in urgent need of further research. This paper reviews the principle and mechanism of CED, summarizes the previous preclinical studies and clinical trials, and briefly introduces the current application difficulties of CED, in order to provide inspiration and reference for the treatment of glioma in China and the design and development of follow-up clinical research.

Meningioma is a common primary tumor of the central nervous system, and benign ones are more common, but there is the possibility of recurrence. In the past, meningiomas were only graded according to histopathological manifestations. Studies on molecular markers of meningiomas can help to further reveal the formation mechanism of meningiomas and guide precise treatment. This review focuses on the clinically significant molecular markers of meningioma.

Circular RNAs are a class of single-stranded non-coding RNAs with covalently closed loop structures. Combined deep sequencing, bioinformatics and molecular biology methods have confirmed that circular RNA has translational function, and its encoded protein or polypeptide can regulate the occurrence and progression of glioma and malignant biological behaviors such as radiotherapy and chemotherapy resistance. In this paper, the biogenesis and functional mechanisms of circular RNA, especially the translation mechanism and related research methods were reviewed, and the research progress of circular RNA translation function in the field of glioma was systematically summarized, in order to provide reference for the study of the pathogenesis and clinical treatment of glioma.

Trigeminal neuralgia is a common neuropathic pain in the head and face. In addition to radiofrequency thermocoagulation and microvascular decompression, percutaneous balloon compression of semilunar node is also an effective treatment mode. This article reviews the research progress of percutaneous balloon compression in the treatment of trigeminal neuralgia, in order to provide reference for the clinical treatment of this disease.