Volume 39 · Issue 06 · 2023

Meningioma is the most common primary intracranial tumor of the central nervous system (CNS), but it is not easy to obtain its complete and accurate pathological diagnosis. On the one hand, the histological classification and World Health Organization (WHO) classification of some meningiomas are not consistent with the clinical biological behavior of tumors, resulting in the existing classification that cannot well assess the prognosis of patients with meningiomas; On the other hand, there is a lack of clear risk stratification indicators for most WHO grade 1 meningiomas. The 5th edition of WHO CNS Tumor Classification 2021 put forward some new standards and principles for the diagnosis and classification of meningiomas. How to correctly understand and apply these new standards has become the focus of pathological diagnosis of meningiomas recently. This article analyzes and discusses the current diagnostic principles of meningioma pathology and its related hot issues, in order to improve the ability of pathologists and clinicians to diagnose and treat meningioma.

To discuss the surgical strategies of neurofibromatosis type 2 (NF2) and to analyze the prognostic factors.

The clinical data of 87 NF2 patients who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from January 2009 to December 2018 were retrospectively analyzed. All patients received optimal surgical strategies that were aimed to protect visual and auditory functions, alleviate key tumor compression, and individualize the timing of surgical intervention. The Karnofsky functional status score (KPS) was used to evaluate the patient′s outcome. An unchanged or increased KPS compared to the preoperative level indicated favorable outcome, while a decreased KPS indicated poor outcome. Univariate and multivariate logistic regression analyses were performed to identify the prognostic factors.

At the last follow-up, the median follow-up time of the 87 patients was 98 months (36-144 months). A total of 54 cases (62.1%) had favorable outcomes, while 33 cases (37.9%) had poor outcomes, including 15 cases of death, 3 cases of a second operation and 15 cases of newly-onset or aggravated neurological dysfunction. Univariate logistic regression analysis showed that the patient′s age of onset≤30 years, diagnosis-to-surgery interval of ≥36 months, maximum tumor diameter of ≥30 mm, low preoperative KPS, and preoperative vision and swallowing dysfunction were risk factors of poor outcomes (all P<0.05). Multivariate logistic regression analysis indicated that age of onset ≤30 years (OR=3.31, 95%CI: 1.06-10.39, P=0.040) and preoperative visual impairment (OR=3.32, 95%CI: 1.08-10.25, P=0.037) were related to the patients′ long-term poor outcomes.

Optimal surgical treatment strategies for NF2 can improve the long-term clinical outcomes of patients. Age of onset ≤30 year and preoperative visual impairment are important risk factors of the patients′ long-term poor outcomes.

To investigate the role of direct electrical stimulation under awake craniotomy in resection of diffuse lower-grade glioma in the eloquent brain areas.

A retrospective study was performed on the clinical data of 38 patients with diffuse lower-grade glioma located in supratentorial eloquent areas who were admitted to the Department of Neurosurgery of General Hospital of Southern Theater Command from February 2017 to July 2020. Among the patients, 9 had recurrent gliomas. All patients underwent awake craniotomy and direct electrical stimulation was performed to locate the cortical/subcortical important functional areas. The extent of excision and postoperative neurological dysfunction were documented.

After intraoperative direct electrical cortical stimulation, 31 cases (81.6%) showed positive response and 7 (18.4%) showed negative response. During subcortical stimulation, 25 cases (65.8%) showed positive response and 13 cases (34.2%) showed negative response. Both cortical and subcortical electrical stimulations induced negative response in 5 cases (13.2%). Total resection was achieved in 21 cases (55.3%), including 5 cases with supratotal resection. Subtotal resection was performed in 13 cases (34.2%) and partial resection in 4 cases (10.5%). A total of 26 cases (68.4%) had new or aggravated neurological dysfunction within 3 months after surgery and 4 cases (10.5%) had irreversible mild-moderate neurological dysfunction after 3 months. Of the 9 recurrent patients, 8 cases underwent resection reaching the boundary of eloquent areas. There were 2 cases who developed mild newly-onset neurological dysfunction at 3 months post operation.

Brain functional mapping using direct cortical electrical stimulation in awake craniotomy can maximize the extent of safe resection of diffuse lower-grade glioma in the eloquent brain areas and help reduce the incidence of postoperative neurological dysfunction.

To investigate the effect of preoperative prognostic nutritional index (PNI) on the clinical prognosis of patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) and WHO grade 4 astrocytoma.

A retrospective study was conducted on the clinical data of 208 patients with WHO grade 4 gliomas confirmed by postoperative pathology who underwent tumor resection in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from February 2015 to May 2021. Among them, there were 161 cases of IDH wild-type GBM and 47 cases of WHO grade 4 astrocytoma (IDH mutant type). X-tile software was used to calculate the optimal boundary point of PNI for patients with two types of gliomas and the survival analysis was performed; Kaplan-Meier method was used to draw survival curve and log-rank test was used to analyze the overall survival rate and progression-free survival rate of patients. Multivariate Cox regression analysis was used to explore the factors influencing the prognosis of glioma.

A total of 208 patients received clinical follow-up with the follow-up time of 15.8±10.3 months. The optimal boundary values for PNI for IDH wild-type GBM and WHO grade 4 astrocytoma were 45.2 and 47.7, respectively. The results of survival analysis showed that PNI ≤ 45.2(24 cases) and PNI>45.2(137 cases) had predictive significance for the overall survival rate and progression-free survival rate of IDH wild-type GBM (all P<0.05), and higher PNI predicted better prognosis. For WHO grade 4 astrocytoma, PNI≤ 47.7(12 cases) and PNI>47.7(35 cases) had no significant effect on overall survival rate or progression-free survival rate (all P>0.05). The PNI difference of IDH mutation state was statistically significant (P=0.040). Univariate log-rank test showed that there was a statistically significant difference in the impact of PNI and chemotherapy on the overall survival rate and progression-free survival rate of IDH wild-type GBM patients, while radiotherapy had a statistically significant effect only on progression-free survival rate (all P<0.05). Multivariate Cox regression analysis showed that PNI and chemotherapy had statistically significant differences in overall survival rate (PNI, HR=0.55, 95%CI: 0.35-0.87; chemotherapy, HR=1.57, 95%CI: 1.04-2.36) and progression-free survival rate (PNI, HR=0.56, 95%CI: 0.36-0.89; chemotherapy, HR=1.52, 95%CI: 1.01-2.27) of IDH wild-type GBM patients(all P<0.05).

PNI is a predictor of prognosis of IDH wild-type GBM rather than WHO grade 4 IDH mutant-type astrocytoma, and PNI has a direct relationship with IDH mutation status. PNI can be used as a potential marker of overall survival rate and progression-free survival rate in GBM patients.

To explore the feasibility and efficacy of preoperative embolization combined with microsurgical resection for the treatment of large solid hemangioblastoma (HB) in the posterior fossa and the possible factors affecting the outcome.

A retrospective study was performed on the clinical data of 21 patients with large HB [maximum diameter >30 mm, accounting for 8.8% (21/238) of HB patients in the posterior fossa treated during the same period] in the posterior cranial fossa who were admitted to the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from June 2012 to January 2022. Five cases (23.8%) were associated with Von Hippel-Lindau (VHL) disease. The tumor was located in the cerebellar hemisphere in 9 cases (42.9%), cerebellopontine angle in 4 (19.0%), and other regions(including the roof of fourth ventricle, superior vermis and inferior vermis of cerebellum, and foramen magnum area) in 8 (38.1%). There were 4 cases (19.0%) with brainstem invasion and 2 cases (9.5%) with multiple lesions. The treatment methods included preoperative endovascular embolization and microsurgical resection of tumor. Clinical data included incidence of postoperative complication, the modified Rankin scale (mRS) score at admission and the last follow-up. Possible factors affecting the occurrence of postoperative complications were explored.

All 21 patients underwent preoperative embolization of tumor feeding artery and the degree of embolization was 60%-80%. All patients underwent microsurgery and the tumors were completely removed. A total of 7 patients (33.3%) had postoperative complications, including 1 case of postoperative bleeding, 2 cases of respiratory dysfunction, 2 cases of lower cranial nerve dysfunction, 1 case of facial paralysis, 1 case of hemiplegia, 1 case of hydrocephalus, 3 cases of lung infection, 1 case of intracranial infection, 1 case of cerebrospinal fluid leakage, 1 case of subcutaneous effusion and 1 case of aggravated dystaxia. Univariate analysis showed that tumor invasion of the brain stem might be the influencing factor of the occurrence of postoperative complications (P=0.006), whereas the patient′s gender, age, disease duration, tumor size or stiffness, preoperative hydrocephalus and preoperative mRS were not influencing factors (all P>0.05). Two patients died after operation. Specifically, 1 case died of postoperative cerebral rebleeding and 1 case died of respiratory complications. Nineteen cases were followed up for 6 to 114 months with a median of 22 months. At the last follow-up, the mRS score was 0 in 9 patients, 1 in 5 patients, 2 in 4 patients and 3 in 1 patient. During the follow-up period, tumor recurrence occurred in 2 cases associated with VHL. One case developed newly-diagnosed right frontal glioma and two cases developed hydrocephalus.

Preoperative embolization of tumor feeding arteries combined with microsurgical resection can lead to favorable outcomes in most patients with large HB in the posterior cranial fossa. The incidence of postoperative complications seems higher in patients with brain stem tumor involvement, and the recurrence rate is higher in patients with VHL disease.

To explore the effect of multimodal navigation in transnasal transsphenoidal (TNTS) resection of pituitary adenoma.

A retrospective analysis was conducted on the clinical data of 138 patients of pituitary adenoma who underwent TNTS resection of tumor with the assistance of multimodal navigation (navigation group) in the Department of Neurosurgery, Peking University Third Hospital from June 2019 to May 2020. The 48 pituitary adenoma patients who were treated with TNTS tumor resection from January 2018 to May 2019 in the same hospital were selected as control group. There was no statistically significant difference in baseline data such as age and gender between the two groups of patients (P>0.05). The efficacy and incidence of complications were analyzed and compared between the two groups.

Compared with the control group, the recognition rates of sphenoid sinus opening [100% (138/138) vs. 91.7% (44/48) respectively] and optic neural groove and carotid artery compression [100% (138/138) vs. 83.3% (40/48)] in the navigation group were higher, the operation time was shorter (67.0±13.2 min vs. 85.6±18.2 min), and the intraoperative bleeding was less [M (Q₁, Q₃): 15 (15, 20) ml vs. 30 (15, 40) ml], and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage [2.9% (4/138) vs. 6.3% (3/48)] or transient diabetes insipidus [4.3% (6/138) vs. 8.3% (4/48)] between the navigation group and control group (both P>0.05). There was no statistically significant difference in total tumor resection rate between the navigation group and control group [93.5% (129/138) vs. 87.5% (42/48), χ²=1.72, P=0.190]. All patients received clinical follow-up, and the follow-up time in the navigation group was shorter than that in the control group (10.1±5.6 months vs. 22.6±6.9 months, t=-12.55, P<0.001). During the follow-up period, the clinical symptoms of both groups improved to varying degrees and there were no patients with low hormone levels. The difference in tumor recurrence rate between the navigation group and control group was not statistically significant [0 vs. 4.2% (2/48), P=0.066].

Multimodal navigation in TNTS resection of pituitary adenoma can help identify anatomical structures, reduce the surgical trauma and shorten the operation time.

To investigate the therapeutic effect and complications of endoscopic third ventriculostomy (ETV) in children with obstructive hydrocephalus caused by posterior fossa tumors.

A retrospective study was conducted on the clinical data of 92 children with posterior fossa tumors admitted to the Department of Neurosurgery, Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from September 2013 to September 2021. All children had symptoms of intracranial hypertension caused by obstructive hydrocephalus and procedures was performed in two stages (ETV first and tumor resection second). Postoperative efficacy and incidence of complications of ETV and recurrence rate of hydrocephalus post tumor resection were determined.

ETV was successfully completed in 98.9% (92/93) of all patients and the symptoms of intracranial hypertension were relieved after ETV. ETV failed in 1 case due to intracranial bleeding. The symptoms of intracranial hypertension were relieved after ETV in all cases. There was 1 case of intracranial infection after operation, which was cured by anti-infection therapy. The complication rate was 1.1% (1/92). The recurrence rate of hydrocephalus was 6.5% (6/92). In all cases of current hydrocephalus, the hydrocephalus was relieved after reoperation and placement of a ventriculoperitoneal shunt.

For children with posterior fossa tumors complicated with obstructive hydrocephalus in need of emergency relief of intracranial hypertension, ETV treatment can relieve the symptoms of intracranial hypertension in time, with few complications and a low recurrence rate of hydrocephalus after tumor resection.

To investigate the clinical characteristics and surgical outcome of skull base endolymphatic sac tumors (ELSTs).

A retrospective analysis was conducted on the clinical data of 7 patients with ELSTs who underwent surgical treatment by the Department of Neurosurgery and Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University from August 2014 to February 2022. The treatment strategy was decided based on multidisciplinary team discussion before operation. Embolization of the feeding artery was performed in 4 patients. In 4 patients with the tumor maximum diameter <3 cm, transmastoid approach was taken. Out of 3 patients with the tumor maximum diameter ≥3 cm, 1 case underwent infratemporal fossa approach and 2 underwent infratemporal fossa approach combined with middle cranial fossa approach or retrosigmoid approach.

The first symptoms of 4 patients were hearing loss and tinnitus. One patient had renal cell carcinoma and was diagnosed as von Hippel-Lindau disease. All patients had different degrees of hearing loss before operation. As for preoperative facial nerve function, there were 4 cases of House-Brackmann(H-B) grade Ⅰ, 1 case of H-B grade Ⅱ and 2 cases of H-B grade Ⅳ. The imaging manifestation of CT was osteolytic bone destruction and MRI showed cystic and solid tumors with abundant blood supply. In 3 patients with the tumor size ≥3 cm, total resection was performed in 1 case and gross total resection in 3 cases. In 4 patients with the tumor size <3 cm, total resection was performed in 2 cases, subtotal resection in 1 case and gross resection in 1 case. The median follow-up time for all patients after operation was 48 months (2 months to 6 years). There was no tumor recurrence in 3 patients receiving total or 1 patient receiving subtotal resection. Out of 2 patients with gross total resection received postoperative radiotherapy, 1 had tumor that disappeared and was followed up for 6 years without recurrence; one was followed-up for 3 years with a trend of tumor shrinkage. One patient died from tumor progression 4 years after surgery, and the remaining 6 cases lived normally.

ELSTs have specific locations and characteristic imaging manifestations. Multidisciplinary collaboration to develop an individualized surgical treatment plan and postoperative adjuvant radiotherapy for the residual tumor could help improve the patients′ outcomes.

To investigate the indications and therapeutic effect of cerebral revascularization in endoscopic treatment of complex skull base tumors involving internal carotid artery (ICA).

A retrospective analysis was conducted on the clinical data of 6 patients with complex aggressive tumors at skull base who underwent neuroendoscopic surgery at Endoscopic Skull Base Surgery Center and Department of Neurosurgery, Tianjin Huanhu Hospital from July 2019 to July 2021. There were 2 cases of relapsing aggressive pituitary adenoma, 1 case of relapsing nasopharyngeal carcinoma, 1 case of relapsing clivus chondrosarcoma, 1 case of relapsing intracranial and extracranial communicating meningioma, 1 case of relapsing ossifying fibroma. According to the extent of invasion and the characteristics of ICA involvement, 2 cases underwent external carotid artery (ECA)-ICA bypass and 4 cases underwent ICA-ICA bypass. Neuroendoscopic surgery was performed for tumor resection after cerebral revascularization. Digital subtraction angiography (DSA) or CT angiography (CTA) was performed regularly to evaluate the degree of tumor resection and patency of anastomotic vessels.

All 6 patients successfully underwent bypass surgery, and immediate postoperative DSA or CTA results confirmed that the anastomoses were unobstructed. Total tumor resection was achieved in 4 cases, partial resection in 1, and subtotal resection in 1. There was no new-onset neurological dysfunction. Preoperative epistaxis of 1 patient disappeared after surgery. One patient developed cerebrospinal fluid rhinorrhea after operation which was resolved after a second repair operation. The follow-up time of 6 patients ranged from 6 to 36 months, and there was no new ischemic stroke. The patency of the graft was confirmed by CTA and DSA.

When performing neuroendoscopic surgery for complex skull base tumors involving ICA, appropriate revascularization techniques should be selected according to the invasion range of the lesion and the characteristics of ICA involvement, which is conducive to resecting the lesion as much as possible and reducing the risks of intraoperative massive hemorrhage and postoperative cerebral ischemia.

To compare the clinical outcomes and complications of Pipeline Flex versus first-generation Pipeline(Classic) flow diverters (FDs) in the treatment of intracranial aneurysms.

A retrospective study was performed on the clinical and imaging data of 862 patients with 1 010 intracranial aneurysms who underwent FD placements in 14 medical centers including Beijing Tiantan Hospital, Capital Medical University from November 2014 to October 2019. The patients were divided into Flex and Classic groups according to the version of FD, and a 1 ∶1 nearest-neighbor propensity score matching was performed to adjust for potential baseline confounding characteristics. After matching, 340 patient pairs were included in both groups (315 patients in the Classic group and 307 patients in the Flex group, 340 procedures performed in both groups), and the efficacy and safety of the two groups were compared.

There was no significant difference in the rate of successful FD deployment to target site between the Classic group and the Flex group [98.8% (336/340) vs. 99.1% (337/340), χ²=0.00, P=1.000]. Compared with the Classic group, the Flex group demonstrated a higher rate of side branch coverage [67.1% (228/340) vs. 57.9% (197/340), χ²=6.03, P=0.014] and a lower rate of ischemic complications during perioperative period [2.9% (10/340) vs. 6.8% (23/340), χ²=5.38, P=0.020]. There was no statistically significant difference in the follow-up duration or complete aneurysm occlusion rate between the two groups of patients (both P>0.05). The Flex group demonstrated a lower rate of ischemic complications during follow-up in comparison with the Classic group [0.3% (1/340) vs. 2.4% (8/340), χ²=4.05, P=0.044]. There was no statistically significant difference in the incidence of other complications between the two groups (P>0.05). At the latest follow-up, the overall rate of ischemic complications in the Classic group was higher than that in the Flex group [9.1% (31/340) vs. 3.2% (11/340), χ²=10.15, P=0.001], while there was no statistically significant difference in the proportion of unfavorable clinical outcomes (mRS scores≥ 2) or mortality rate (both P>0.05).

Compared with Pipeline Classic FD, Pipeline Flex FD has a comparable therapeutic efficacy in the treatment of intracranial aneurysms, while it could help reduce the occurrence of ischemic complications.

To establish a nomogram model for prediction of the risk of postoperative central nervous system infection (CNSI) in patients with severe neurological diseases.

The clinical medical records of 1 264 patients who underwent neurosurgical treatment in the Department of Critical Medicine, Renmin Hospital of Wuhan University from January 2020 to January 2022 were retrospectively collected. In this series, 987 patients admitted to the Department of Intensive Care at the Shouyi campus were used as the training set; 277 patients admitted to the Department of Critical Care Medicine at the Guanggu campus were used as the validation set. Univariate and multivariate logistic regression analyses were used to identify the risk factors of postoperative CNSI in patients with severe neurological diseases and build a nomogram model. The prediction accuracy and judgment ability of the nomogram model were evaluated by the receiver operating characteristic curve, C index and calibration curve. The clinical application value of the nomogram model was evaluated by the decision curve analysis. The model was internally verified in the validation set.

A total of 1 264 severe patients after neurosurgery were included in this study, of which 146 cases (11.6%) developed CNSI. A total of 1 264 severe patients after neurosurgery were included in this study, of which 146 cases (11.6%) developed CNSI, including 102 (10.3%, 102/987) in the training set and 44 (15.9%, 44/277) in the validation set.Multivariate logistic regression analysis showed that diabetes history, APACHE Ⅱ score ≥10, emergency operation, operation time≥4 h, postoperative lumbar cistern drainage, postoperative extraventricular drainage, intraoperative bleeding ≥400 ml, combination with shock, postoperative albumin ≤30 g/L and intensive care unit (ICU) stay≥3 days were independent risk factors for CNSI in patients with severe neurological diseases after operation. The area under the curve (AUC) of the training set was 0.79 (95%CI: 0.75-0.84) and that of the validation set was 0.72 (95%CI: 0.65-0.80). The calibration curves between training set and verification set showed P values of 0.267 and 0.179 respectively by Hosmer-Lemeshow test. The analysis of clinical decision curve showed that the threshold probabilities of the training set and the validation set were 0-0.8, and the net benefit rate was >0, suggesting that the nomogram prediction model has high clinical application value.

The nomogram model constructed based on the risk factors of postoperative CNSI in neurocritically ill patients has good predictive ability, which is helpful to identify patients with high risk of CNSI, administer early intervention, and reduce the risk of postoperative CNSI in neurocritically ill patients.

To evaluate the application value of preoperative three-dimensional(3D)multimodal image reconstruction in neuroendoscopic microvascular decompression (MVD).

The clinical data of 48 patients who received neuroendoscopic MVD treatment in Neurosurgery Department of Weifang People′s Hospital from April 2019 to December 2021 were retrospectively analyzed, including 18 cases of trigeminal neuralgia(TN) and 30 cases of hemifacial spasm(HFS). All patients underwent cranial MRI three-dimensional fast imaging employing steady-state acquisition(3D-FIESTA) and three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA) examinations before operation, imaging fusion was performed and reconstruction of nerves, blood vessels and other structures was made. Kappa consistency test was used to evaluate the consistency of the offending vessels, the course of the offending vessels and the contact relationship between the offending vessels and the nerve or the nerve exit/entry brain stem area (REZ), and the degree of pressure of the offending vessels on the nerves seen in the preoperative three-dimensional reconstruction of multi-modal images and neuroendoscopic MVD. According to the TN pain classification or the HFS intensity classification, the improvement of the symptoms of the patients at 1, 3, and 6 months after operation was evaluated.

Preoperative 3D multimodal image reconstruction of 48 patients showed that there were 3 patients whose offending vessels could not be identified and the other 45 patients had clear offending vessels. Neuroendoscopic MVD was successfully completed for all patients, 46 of whom had clear offending vessels. The accuracy of 3D reconstruction of multi-modal images in identifying offending vessels was 91.3% (42/46), the accuracy of judging vascular shape and neurovascular relationship was 93.7% (45/48), and the accuracy of judging the degree of vascular compression on nerve was 100% (21/21). The results of Kappa consistency test showed that the offending vessels, the course and their contact relationship with nerve or REZ, and the degree of vascular compression on nerve were moderately consistent between the 3D reconstruction of multi-modal images and neuroendoscopic MVD(Kappa coefficient: 0.63, 0.74, 0.68, all P<0.001). None of the 48 patients had intracranial infection or recurrence, the median follow-up time was 4 months (1-6 months). The latest follow-up showed that in the case of 18 TN patients, 17 recovered and 1 had partial remission; in 30 patients with HFS, 29 recovered, 1 significantly remission.

Preoperative application of multimodal fusion 3D reconstruction technology can accurately evaluate the offending vessels, the course of offending vessels, their contact relationship with nerve or the REZ and the degree of vascular compression on nerve, which is helpful to improve the accuracy and success rate of neuroendoscopic MVD and effectively reduce the cranial nerve irritation.

To analyze the infiltration degree of reactive astrocytes in glioma microenvironment based on single-cell RNA sequencing data, and to investigate its transcriptomic characteristics.

Single-cell RNA sequencing data from GSE103224 (23 793 cells) and GSE138794 (20 278 cells) datasets were used to analyze characteristic gene expression profile using R software " Seurat" package. Based on the established tumor-associated reactive astrocyte characteristic genes, the " AddModuleScore" command in the " Seurat" package was used to calculate the characteristic gene expression score of each cell, and those whose expression score increased significantly were defined as tumor-associated reactive astrocyte subsets (i.e., target subsets). The " FindMarkers" command in the " Seurat" package was applied to identify differentially expressed genes between target subsets and others [fold change >2.0 (high expression) or <0.5 (low expression), adjusted P<0.05] among target markers. The up-regulated genes in the intersection of target subgroups in the two data sets were analyzed, and functional annotation of the up-regulated genes was analyzed according to the biological functions of DAVID database.

According to the expression profiles, the cells in GSE103224 and GSE138794 data sets could be divided into 26 subgroups, with 4 and 5 target subsets respectively. The cells of the target subsets in GSE103224 and GSE138794 data sets accounted for 15.6% (3 712/23 793) and 16.5% (3 347/20 278) of the total cells respectively. Differential analysis showed that there were 229 differentially expressed genes between the 4 target subsets in the GSE103224 dataset and other subsets, among which 136 were up-regulated genes and 93 were down-regulated genes. In the GSE138794 dataset, there were 422 differential genes between the 5 target subsets and other subsets, among which there were 270 up-regulated genes and 152 down-regulated genes. There were 94 up-regulated genes and 50 down-regulated genes with intersection between the two data sets. Gene function annotation results showed that 94 overlapping up-regulated genes were significantly correlated with 37 gene functions (FDR<0.05), which mainly included immune response, microglia activation, ERK pathway, tumor necrosis factor pathway, apoptosis pathway, etc.

The results of single-cell analysis showed that tumor-related reactive astrocytes are common in the glioma microenvironment, and their functions may be related to the immune response and ERK pathway during the development of glioma.

To investigate the expression and significance of synaptogenesis related proteins synaptosomal-associated protein (Snap) 25 and Synapsin1 and mitochondrial dysfunction related proteins monoamine oxidase B (Maob) and NADH dehydrogenase (ubiquinone) Fe-S protein 2 (Ndufs2) in hippocampus of rats with acute traumatic brain injury (TBI).

The moderate TBI model was established by applying controlled cortical injury (CCI) to rats. The time point of 48 h after CCI (CCI group, n=13) was set for observation in the acute phase. The sham group (n=13) underwent the same procedure without percussion. The expression of differential proteins between CCI group (n=5) and sham group (n=5) was analyzed by ultra-high performance liquid chromatography and isotope labeled relative and absolute quantitative (iTRAQ) protein mass spectrometry. Bioinformatics methods were employed to analyze the cellular components, biological processes and molecular functions of differential proteins, and classical pathway enrichment analysis and disease function enrichment analysis were carried out. The ultrastructural changes of neuronal nuclei and mitochondria in the hippocampus of the two groups were observed by transmission electron microscopy. The expression of Snap25, Synapsin1, Maob and Ndufs2 proteins were detected by Western blot (WB).

The results of protein mass spectrometry showed that compared with the sham group, 55 differential proteins were up-regulated in CCI group (fold change ≥1.50) and 110 differential proteins were down-regulated (fold change ≤0.65). Bioinformatics analysis showed that the enriched classical pathways included synaptogenesis signaling pathway [-log₁₀ (P value) = 7.29] and mitochondrial dysfunction signaling pathway[-log₁₀ (P value) = 4.06]; Snap25 and Synapsin1 were enriched in synaptogenesis signaling pathway; Maob and Ndufs2 proteins were enriched in mitochondrial dysfunction signaling pathway. Electron microscopy demonstrated that the CCI group had pyknosis of neuron nucleus and rupture of mitochondrial crista. WB results showed that compared with sham group (n=5), the relative protein levels of Snap25 (0.594±0.025 vs. 1.000±0.141, t=4.92), Synapsin1 (0.597±0.077 vs. 1.000±0.100, t=5.56), Maob (0.528±0.042 vs. 1.000±0.160, t=4.94) and Ndufs2 (0.549±0.057 vs. 1.000±0.131, t=5.45) were decreased in CCI group (n=5). The differences were statistically significant (all P<0.01).

The expression levels of synapsogenesis related proteins (Snap25 and Synapsin1) and mitochondrial dysfunction related proteins (Maob and Ndufs2) are decreased in the hippocampus of CCI rats, which may be involved in the pathogenesis of TBI.

Calcified chronic subdural hematoma (CCSDH) is rare, and there are many postoperative complications treated by traditional craniotomy. The Department of Neurosurgery, Nantong University Affiliated Hospital, removed 2 cases of CCSDH assisted by rigid neuroendoscopy from August 2020 to October 2021. The symptoms of the patients disappeared after operation, and no complications such as bleeding, infection and epilepsy occurred. No recurrence was observed at follow-up.

Murine sarcomatoid virus oncogene homologue (BRAF) non-V600E mutant astrocytoma rare. In January 2022, a patient with BRAF P.T599DUP mutant astrocytoma was diagnosed in the Department of Pathology of Suzhou Dushu Lake Hospital (Dushu Lake Hospital affiliated to Suzhou University). The patient underwent left temporal lobe tumor resection in neurosurgery department. The tumor reached total resection, and the patient recovered well after operation. Follow-up for 14 months showed no tumor recurrence.

Cryptococcal granuloma of the central nervous system is rare, and its clinical manifestations are mainly dizziness, headache, low fever and intracranial hypertension, which is easy to be misdiagnosed in clinic. A patient with cerebellar cryptococcal granuloma with headache and unstable walking as the main manifestations was reported. Preoperative imaging diagnosis was right cerebellar hemisphere occupation. After admission, elective surgical resection of the lesion was performed. Pathological examination confirmed cryptococcal granuloma. After operation, amphotericin B combined with flucytosine was treated with antifungal therapy for 1 month, and no intracranial recurrence was observed after 3 years follow-up.

Obstructive hydrocephalus is a common complication of thalamic hemorrhage. The Department of Neurosurgery of Chengyang District People's Hospital of Qingdao performed lateral ventriculocentesis to treat a patient with thalamic hemorrhage in July 2020, and the patient's condition improved after the operation; Three weeks after operation, delayed obstructive hydrocephalus complicated with paroxysmal sympathetic hyperexcitation appeared. After the third ventriculostomy operation, the symptoms of hydrocephalus and paroxysmal sympathetic hyperexcitation were improved, and the prognosis was good.

Chordoma is a rare malignant tumor. Except for surgical resection, traditional radiotherapy and chemotherapy are not effective. Therefore, it is very important to explore drugs or means that can help surgical treatment. At present, the research related to immune microenvironment has made some progress in some tumors. On the one hand, it reveals the mechanism of tumor occurrence and development; On the other hand, it provides new therapeutic targets and therapeutic strategies, some of which have been used in clinical trials. Therefore, in recent years, many scholars have carried out research on the immune microenvironment of chordoma, in order to discover new targets, drugs or means for the clinical treatment of chordoma. This article reviews the research progress and therapeutic value of immune microenvironment, especially immune checkpoint, in chordoma by combing relevant literature.

Fisch type D paraganglioma is a common type of paraganglioma in the tympano-jugular foramen area, and surgical resection is the first choice of treatment. The most common choice is to use the inferior temporal fossa approach type A for primary surgery, but how to avoid serious postoperative complications is still a huge challenge in the treatment of this disease. This article summarizes the surgical treatment strategies of Fisch type D paraganglioma by reviewing the literature. One-stage surgery is suitable for patients with Di1 paraganglioma, while staged surgery is more suitable for patients with Di2 and Di3 paraganglioma. Preoperative endovascular embolization of Fisch type D paraganglioma can safely and effectively block the tumor blood supply and reduce the total tumor volume. Postoperative radiotherapy can improve the progression-free survival rate of patients. Elderly patients without posterior group cranial nerve dysfunction are the main objects who choose the short-term "observation and follow-up" strategy.

At present, craniotomy clipping and endovascular treatment are still the main treatment methods for intracranial aneurysms. In recent years, transnasal endoscopic clipping is another feasible method for the treatment of specific intracranial aneurysms, especially for anterior and posterior circulation arterial aneurysms where the ventral skull base can be directly exposed. However, there are few cases currently studied and clinically treated for the anatomical approach of this procedure, and the existing cases report high rates of postoperative complications and clipping failure. Therefore, this article mainly reviews the anatomical feasibility, clinical safety and effectiveness of endoscopic clipping in the treatment of intracranial aneurysms, in order to provide help for the clinical implementation of this procedure.

Refractory intracranial hypertension (RIH) is one of the important causes of poor prognosis in patients with craniocerebral trauma, and it is also a difficult treatment point in neurosurgery. The definition of RIH is still not unified, and the disagreement is mainly focused on the pressure threshold and duration of intracranial pressure increase. There are many clinical methods for treating RIH, including decompressive craniectomy, barbiturate therapy, mild hypothermia therapy, hypertonic saline solution, lumbar puncture and drainage, and cisternostomy, etc. However, the therapeutic effect of these methods and the prognosis of patients are still controversial. This article reviews the definition, pathophysiology and research status of different treatment methods of RIH, in order to provide reference for the clinical diagnosis and treatment of RIH.

Stereoscopic electroencephalography (SEEG) is a minimally invasive technique for localization and treatment of epileptic foci. SEEG technology extends EEG recording electrodes from the scalp to the brain, and can implant dozens or even hundreds of electrode contacts into the brain at the same time, forming a three-dimensional network, so as to accurately record local neuronal discharges in different areas of the brain, with high spatial and high temporal resolution. SEEG technology is currently one of the clinically recognized ways to realize long-term recording of electrical signals in human brain in awake state. More and more researchers use this technology to carry out research on the neural mechanism of human advanced cognitive function. This paper systematically summarizes the data analysis methods of SEEG and its advantages in cognitive research, and emphatically summarizes the research achievements of SEEG in advanced cognitive functions such as hearing, vision, semantics, memory and emotion.