Volume 39 · Issue 08 · 2023

Congenital spinal neural tube malformation is a kind of congenital structural malformation, which seriously endangers the physical and mental health of children. Early detection and timely treatment can help improve the prognosis of children. In recent years, with the development and improvement of prenatal examination technology, the level of prenatal diagnosis of congenital spinal neural tube malformation has gradually improved, and the understanding and attention of pediatric neurosurgeons to this disease has also been deepened. This article focuses on the prenatal diagnosis methods of congenital spinal neural tube malformation, the current status of clinical intervention, and the existing problems and prospects in clinical practice.

To investigate the survival and prognosis of children with postoperative cerebellar mutism syndrome (CMS) after resection of medulloblastoma and the influencing factors.

A retrospective analysis was conducted on the clinical data of 104 children with medulloblastoma who underwent surgical resection in the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from April 2013 to June 2018. All children were divided into two groups according to whether postoperative CMS occurred. Based on the different symptomological manifestations, children with postoperative CMS were divided into silent CMS group and classic CMS group. According to the CMS survey proposed by the Children′s Oncology Group in 2006, the severity of mutism symptoms in children with CMS was graded and evaluated. The Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS) of the children, and the log-rank analysis was used to compare the survival differences between different groups. Univariate and multivariate Cox regression analysis were used to investigate the factors influencing the survival and prognosis of children with medulloblastoma who developed CMS.

As of June 2020, the median follow-up time of 104 children was 52 months (24-107 months). A total of 78 cases (75.0%) survived, 26 cases (25.0%) died and 36 cases (34.6%) had tumors relapse. A total of 40 cases (38.5%) developed CMS, including 9 cases of silent type and 31 cases of classic type. Compared with children with silent CMS, children with classic CMS had higher scores in the scores of mutism and irritability (both P<0.05). There was no significant difference in the 5-year PFS and OS of children with medulloblastoma whether CMS occurred or not (both P>0.05). The 5-year PFS of children with silent CMS was higher than that of children with classic CMS (P=0.047), but there was no significant difference in 5-year OS between the two groups (P=0.165). Multivariate Cox regression analysis showed that tumor dissemination occurring before operation (HR=9.91, 95%CI: 2.37-41.43, P=0.002) and whether the tumor invaded the middle cerebellar peduncle (HR=0.13, 95%CI: 0.03-0.54, P=0.005) were independent influencing factors of PFS in children with CMS.

CMS is a common complication after surgery for medulloblastoma in children, and whether CMS occurs after surgery does not affect the survival prognosis of children. Among them, children with silent CMS have milder symptoms than children with classic CMS, and their survival prognosis is relatively better. In addition, preoperative tumor dissemination and tumor invasion of the middle cerebellar peduncle are unfavorable factors affecting the survival and prognosis of children with postoperative CMS.

To investigate the treatment strategy of brain stem gliomas in children and to conduct a survival analysis.

A retrospective analysis was conducted on the clinical data of 56 children with brain stem gliomas admitted to the Department of Neurosurgery, Children′s Hospital of Soochow University from January 2015 to July 2022. Brain stem gliomas were divided into two groups: diffuse type(31 cases)and focal type (25 cases) including focal intrinsic gliomas (10 cases), exophytic gliomas(10 cases), and cervicomedullary gliomas (5 cases). Among the children with diffuse intrinsic gliomas, 12 cases were treated with a comprehensive treatment strategy based on radiotherapy, 1 case with chemotherapy, 18 cases were followed up. The children with focal gliomas were treated with a comprehensive treatment strategy based on surgery (operation was performed in 19 patients ). The survival of the patients was followed up, and the related factors affecting the outcomes were analyzed.

The 56 patients were followed up for 2-83 months, 32 patients died and 24 patients survived. Kaplan-Meier survival analysis showed that the median survival time of 56 patients was 15 months, and the 1-year and 3-year survival rates were 57.1% and 36.7%, respectively. Of the 31 patients with diffuse intrinsic gliomas, 29 patients died and 2 patients survived. The median survival time was 10 (2-31) months. The median follow-up time of 10 patients with focal intrinsic gliomas was 39 (19-72) months, 2 patients died and 8 patients survived. The median follow-up time of 10 children with exophytic gliomas was 27 (18-83) months. Three children with high-grade gliomas died and the other seven patients survived. Five patients with cervicomedullary gliomas survived, and the median follow-up time was 46 (28-80) months. All of the 56 patients were followed up for at least 18 months. Among them, the 18-month survival rate was low in children with the following factors: aged 5 to 10 years, pre-treatment duration of symptoms lasting for less than 1 month, tumor location in the pontine, WHO high-grade gliomas (33 cases with pathological diagnosis) and diffuse gliomas. The differences were statistically significant (all P<0.01).

Individualized treatment is the main strategy and children with low-grade glioma could benefit from surgery. The overall survival time of brain stem gliomas in children seems short. The duration of symptoms before treatment, age, tumor type, the grade of tumor pathology and tumor location are the possible factors affecting the survival time.

To investigate the clinical characteristics and surgical efficacy of vestibular schwannomas (VSs) of different textures.

The clinical data of 116 patients with medium and large VSs admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2017 to December 2021 were retrospectively analyzed. According to tumor texture, they were divided into cystic group (39 cases, 33.6%) and solid group (77 cases, 66.4%). The clinical characteristics, degree of tumor resection, postoperative complications, proportion of good facial nerve function (House-Brackmann grade Ⅰ and Ⅱ) and tumor recurrence rate were analyzed and compared between the two groups. In addition, clinical efficacy comparison was conducted between the cystic group and solid group in patients with Koos grade Ⅲ and grade Ⅳ, respectively.

The cystic group had a shorter course of disease, larger maximum tumor diameter, and higher Koos grade compared to the solid group with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of postoperative complications, follow-up time, good facial nerve function rate at discharge and last follow-up or recurrence rate between the cystic group and the solid group patients (all P>0.05). The proportion of total resection in the cystic group was lower than that in the solid group [30.8% (12/39) vs. 71.4% (55/77), P<0.001]. In patients with Koos grade Ⅲ (7 cases in the cystic group and 32 cases in the solid group) and grade Ⅳ (32 cases in the cystic group and 45 cases in the solid group), the proportion of total tumor resection in the cystic group was lower than that in the solid group (both P<0.05); there was no statistically significant difference in the incidence of postoperative complications, follow-up time, good facial nerve function at discharge and last follow-up, or recurrence rate between the cystic and solid groups (all P>0.05).

Among patients with medium and large VSs, cystic VSs have the clinical characteristics of rapid growth and short course of disease. The proportion of total tumor resection of cystic VSs is lower than that of solid VSs, and the postoperative complications, facial nerve function and recurrence rates are similar.

To investigate the therapeutic effect and treatment experience of resection of tuberculum sellar meningiomas (TSMs) through lateral frontal basal approach.

A retrospective analysis was performed on the clinical data of 41 patients with TSM treated via the lateral frontal basal approach from December 2015 to November 2021 in the Department of Neurosurgery of the Second Hospital of Lanzhou University. Among them, lateral supraorbital approach was chosen in 14 cases and frontolateral approach in 27. For small laterally spreading tumors, a contralateral approach was used. Simpson grading was used to evaluate the degree of tumor resection. The visual acuity and visual field of the patients were evaluated 1 week after operation. At 3 months after discharge and every year thereafter, head MRI was re-examined to judge whether there was tumor recurrence.

Among 39 patients with visual dysfunction, 31 cases underwent excision of falciform ligament for resection of residual tumor in the optic nerve canal, 2 cases underwent deroofing of the upper wall of optic canal, 1 case underwent anterior clinoidectomy, and 5 cases underwent excision of falciform ligament only for decompression of optic nerve. Among the 41 patients, 39 cases achieved total resection (Simpson grade Ⅰ in 10 cases and grade Ⅱ in 29 cases) and 2 cases achieved partial resection (Simpson grade Ⅳ in 2 cases). Of 39 patients (63 eyes) with abnormal visual acuity and/or visual field before surgery, 31 patients (50 eyes) improved, 5 patients (8 eyes) remained stable, and 3 patients (5 eyes) deteriorated. Among the 27 patients undergoing surgery via frontolateral approach, 1 patient developed intraoperative rupture of internal carotid artery and partial infarction of caudate nucleus and hypothalamus. Intracranial infection occurred in 1 case post operation. Among 14 patients undergoing surgery via lateral supraorbital approach, 1 patient suffered from obstructive hydrocephalus caused by sellar region errhysis. Two patients developed transient impaired consciousness post operation. Intracranial infection occurred in 1 case post operation. The follow-up time of 41 patients was 18±5 months (2-73 months). Up to the last follow-up, 3 cases relapsed.

Lateral frontal basal approach engenders high rate of total tumor resection of TSMs. In the majority of cases, removing the residual tumor in the optic nerve canal could be achieved by only incising of the falciform ligament during operation. The surgery demonstrates relatively good safety. The overall improvement rates of postoperative visual acuity and visual field are high.

To evaluate the effect unilateral hearing loss on quality of life and cognitive function in patients with vestibular schwannoma.

From December 2016 to December 2020, 52 patients with ipsilateral hearing loss caused by unilateral vestibular schwannoma (vestibular schwannoma group), including the right vestibular schwannoma group (referred to as the right group, 26 cases) and left vestibular schwannoma group (referred to as the left group, 26 cases), who were admitted to the Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University were prospectively enrolled into this study. At the same time, 52 healthy people matched in age, gender, and years of education were included as healthy control groups. The hearing evaluation was performed by the same doctor in the Otolaryngology Department of the hospital to measure the pure tone hearing threshold. Cognitive function was evaluated by multiple cognitive function scales such as the Mini-Mental State Examination (MMSE), and the quality of life was evaluated by the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale, and comparisons were made between groups. Pearson correlation analysis was used to evaluate the relationship between hearing loss and cognitive function and quality of life scores in the vestibular schwannoma group.

Compared with the healthy control group, the scores of Boston naming test, memory and execution, AVLT-short-term delayed recall, AVLT-long-term delayed recall, word fluency test, and number and symbol conversion test were lower (all P<0.05) and scores of wired test B were higher (P<0.001) in the vestibular schwannoma group. The vestibular schwannoma group had lower quality of life scores than the healthy control group (P<0.001). Compared with the healthy control group, the scores of AVLT-short-term delayed recall, AVLT-long-term delayed recall, number and symbol conversion test, word fluency test and the quality of life were lower in the right and left vestibular schwannoma groups, and the scores of wired test B were higher (all P<0.05). The scores of Boston naming test, memory and execution in the right group were lower than those in the healthy control group (all P<0.05). The results of Pearson correlation analysis showed that the mean pure tone hearing threshold on the affected side was positively correlated with the B-score of the connection test (r=0.57, P<0.001), negatively correlated with the score of the number sign conversion test (r=-0.79, P<0.001), and negatively correlated with the quality of life score (r=-0.63, P<0.001).

Patients with vestibular schwannoma with unilateral hearing loss have decreased cognitive function and quality of life, and patients with right vestibular schwannoma have more cognitive decline than those with left vestibular schwannoma.

To compare the efficacy of mechanical thrombectomy for the treatment of different subtypes of basilar artery occlusion.

The clinical data of 96 patients with acute ischemic stroke caused by basilar artery occlusion treated in the Department of Neurointervention and Neurointensive Care of Dalian Municipal Central Hospital from January 2019 to June 2022 were retrospectively analyzed. The patients were divided into three groups according to the pathological subtypes of stroke mechanism: embolization without vertebral artery stenosis (group 1, 33 cases), vertebral artery stenosis with basilar artery occlusion (group 2, 30 cases), and in situ atherosclerotic thrombosis in the basilar artery (group 3, 33 cases). Whole-brain digital subtraction angiography was performed after surgery, and the revascularization was evaluated according to modified cerebral infarction thrombolysis (mTICI) grading system. Cranial CT was performed to evaluate intracranial hemorrhage. The outcome of patients was evaluated by modified Rankin scale (mRS) 90 days after surgery. The baseline data, recurrence rate, operation time and postoperative complications of the three groups were compared.

The preoperative baseline data of the three groups showed no statistical significance in the sex, age, etc among patients with different mechanisms of ischemic stroke (all P>0.05). Basilar artery occlusal site, hyperlipidemia, atrial fibrillation and other factors had statistical significance (all P<0.05). All the 96 patients underwent endovascular therapy successfully, 91 cases(94.8%) had successful recanalization.There was no significant difference in the preferred endovascular treatment and the vascular recanalization rate among the three groups (all P>0.05). The time from onset to puncture, operation time, onset to recirculation time in groups 2 and 3 were longer than those in group 1, and the differences were statistically significant (all P<0.05). All patients were followed up 90 days after surgery, 31 cases (32.3%) had good outcomes(mRS≤2 points) and there were no significant differences in proportion of good outcomes, death or postoperative complications among the three groups (all P>0.05). Multivariate logistic regression analysis showed that after adjusting the time from onset to recanalization, different groups were not associated with good clinical outcomes (P=0.132).

The time from puncture to recanalization of different subtypes of basilar artery occlusion may be different after individualized mechanical thrombectomy, but the effects of mechanical thrombectomy are similar.Basilar artery occlusion patients without vertebral artery stenosis have a shorter time interval to successful recalculation, but this is not associated with favorable prognosis.

To investigate the efficacy and safety of hypoglossal-facial nerve anastomosis in the treatment of peripheral facial paralysis associated with surgery for cerebellopontine angle lesions.

A retrospective analysis was conducted on the clinical data of 37 patients with peripheral facial paralysis after resection of cerebellopontine angle lesions who were admitted to the Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital from July 2011 to March 2022. All patients underwent hypoglossal-facial nerve end-to-end anastomosis. The facial nerve function of patients before and after operation was evaluated by House-Brackmann (H-B) grading system and the complications after anastomosis were documented. There were 3 cases of H-B grade Ⅴ and 34 cases of H-B grade Ⅵ before operation. We also explored the factors affecting the recovery of facial nerve function in patients.

At 12 months post operation, H-B grade Ⅱ was reported in 4 cases, grade Ⅲ in 29 cases, grade Ⅳ in 3 cases and grade Ⅴ in 1 case. The rate of effectiveness (defined as postoperative H-B grade of Ⅰ-Ⅲ) was 89.2% (33/37). The recovery of facial nerve function was related to the course of facial paralysis (P=0.001), which it had no correlation with the patient′s gender, age or preoperative H-B grade (all P>0.05). At 12-month follow-up post operation, there were no significant complications such as dysarthria or dysphagia.

Hypoglossal-facial nerve end-to-end anastomosis is an effective method for peripheral facial paralysis after resection of cerebellopontine angle lesions and the complications seem mild. Patients with facial paralysis lasting for ≤ 6 months may have better facial nerve function recovery after anastomosis.

To preliminarily observe the feasibility and clinical efficacy of stereoelectroencephalography (SEEG)-guided multi-contact radiofrequency thermocoagulation (RF-TC) in the treatment of epilepsy due to perinatal brain injury.

A retrospective analysis was conducted on the clinical data of 7 patients with intractable epilepsy due to perinatal brain injury who underwent SEEG-guided multi-contact RF-TC at the Department of Neurosurgery, Tsinghua University Yuquan Hospital from January 2014 to June 2021. The MRI scan of 6 patients showed bilateral lesions and 1 patient showed right parietal lobe lesion. Positron emission tomography (PET)-CT showed significant decrease of glucose uptake in bilateral posterior cortices during the interictal period of all patients. All patients underwent implantation of SEEG and SEEG-guided multi-contact RF-TC. All patients were reviewed 3 months, 6 months, and 1 year after RF-TC. The follow-up content included EEG and MRI. The outcome was evaluated based on the Engel grading system.

The RF-TC process of 7 patients was all smooth, among which 2 cases underwent 1 procedure of RF-TC, 3 cases underwent 2 procedures (times) of RF-TC, and 2 cases underwent 3 procedures RF-TC. One patient had a transient visual aura during the thermocoagulation process which disappeared after the thermocoagulation ended. No surgical complications occurred in the 7 patients during or after thermocoagulation. The follow-up time of 7 patients ranged from 18 to 52 months. Two cases were seizure free after operation, 2 cases had reduced or alleviated seizures, 1 case had no improvement after operation, and 2 cases had recurrence (6 and 12 months after operation respectively). One patient with reduced seizures underwent laser ablation of the left tectum 6 months after the operation. One case underwent focal resection of the right parietal lobe due to seizure recurrence 6 months after the operation, and there was no seizure after the operation. At the last follow-up, there were 4 cases of Engel grade Ⅰ, 2 cases of grade Ⅲ, and 1 case of grade Ⅳ.

Primary observation has shown that SEEG-guided multi-contact RF-TC is feasible and safe in the treatment of epilepsy due to perinatal brain injury. Epileptic seizures can be improved to a certain extent post operation, but seizure recurrence can be observed in some patients.

To investigate the clinical characteristics and treatment outcomes of pituitary hyperplasia caused by primary hypothyroidism.

The clinical data of 15 patients with pituitary hyperplasia caused by primary hypothyroidism admitted to the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from June 2015 to May 2021 were retrospectively analyzed. The clinical symptoms, laboratory tests and imaging data of the patients were collected. All 15 patients were treated with oral levothyroxine sodium at a maintenance dose of 50-150 μg/d; a 10-year-old child with developmental delay was also given growth hormone for 2 years. The symptoms, endocrine and MRI findings of the sellar region were followed up by telephone or outpatient service.

Fifty patients mainly presented with symptoms of hypothyroidism (fatigue, chills, headache, swelling, etc.). Among them, 5 children had growth retardation. Endocrine examination showed that the level of thyroid hormone decreased, and the thyrotropin was >100 μIU/ml, and the prolactin level increased to varying degrees (30.33-137.00 ng/ml). The growth hormone levels of 3 adolescent patients were normal, but insulin-like growth factor levels were significantly lower than normal. MRI of the sellar region showed that the lesions were mostly iso-T1 and iso-T2 signals, and the posterior lobe of the pituitary gland with short T1 signals in stripes could be seen behind. The upper smooth edge of the lesions showed symmetric hill-shaped projection. The height of the pituitary was 13.7±3.2 mm (range: 10.0-21.0 mm). The median follow-up time of 15 patients was 35 months (range: 12-63 months). Symptoms and endocrine examinations of 15 patients gradually returned to normal after one month of treatment. Ten patients completed imaging follow-up, and the median follow-up time was 4.5 months (range: 1-18 months). MRI results of the sellar region indicated that the pituitary gland height after treatment was 6.6±2.3 mm (range: 3.4-12.0 mm), which was decreased compared with that before treatment (t=15.35, P<0.001).

The clinical manifestations, endocrine examination and MRI manifestations of pituitary hyperplasia caused by primary hypothyroidism have certain characteristics. After thyroxine replacement therapy, the prognosis is good. Attention should be paid to distinguish it from pituitary adenoma and avoid surgical treatment.

To investigate clinical therapeutic effect of intraventricular lavage and intraventricular administration of polymyxins in post-neurosurgical patients with pyogenic ventriculitis caused by multi/extensive drug-resistant (MDR/XDR) Acinetobacter baumannii.

A retrospective analysis was conducted on the clinical data of patients with post-neurosurgical pyogenic ventriculitis caused by MDR/XDR Acinetobacter baumannii who were admitted to the Neurosurgical Department of Shanghai Tenth People′s Hospital affiliated to Tongji University from January 2014 to June 2020. All of the patients underwent intraventricular lavage followed by daily intraventricular polymyxins injection. Intravenous antibiotic strategy was mainly based on tigecycline and/or polymyxins. Outpatient follow-up was performed after discharge. The patient′s outcome was assessed by the Glasgow Outcome Scale (GOS) at 3 months after discharge.

Thirty-nine patients were enrolled in this study. Thirty-four (87.2%) patients were clinically cured and discharged, and 5 patients died. The mean duration of intraventricular administration of polymyxins was 24.3±15.3(5-65) days. Hydrocephalus was present in 33 (84.6%) patients, including 15 with multiloculated hydrocephalus and 18 with uniloculated hydrocephalus. The duration of intraventricular injection of polymyxins was significantly longer in patients with multiloculated hydrocephalus than in those without multiloculated hydrocephalus (31.0±16.6 days vs. 20.1±13.1 days, t=2.29, P=0.028), and the GOS score was significantly lower than in patients with multiloculated hydrocephalus than in those without multiloculated hydrocephalus [2 (2, 2) vs. 3 (2, 4), Z=-2.47, P=0.017]. After the cure of infection, 30 patients underwent ventriculo-peritoneal shunt, and 2 patients received lumbar-peritoneal shunt. No recurrence of infection occurred in any patients after shunt.

Intraventricular lavage combined with intraventricular injection of polymyxins is an effective way for the treatment of post-neurosurgical pyogenic ventriculitis caused by MDR/XDR Acinetobacter baumannii. Hydrocephalus is a common complication and the occurrence of multiloculated hydrocephalus is associated with poor prognosis.

To explore the feasibility of contralateral cervical 7 (C₇) nerve transfer surgery via subdural approach with a single incision in the spinal canal based on anatomical research.

Four fresh frozen cadaver specimens were used for the study. The operation was performed under neuroendoscope and microscope to observe and measure the length of C₇ nerve from its exit from the dura mater to the fusion of anterior and posterior roots of intervertebral foramen. We then divided the nerve sub-bundles of the healthy anterior root into 3 bundles, the nerve sub-bundles of the affected anterior root into an average of 3 bundles, and the nerve sub-bundles of the healthy and affected posterior roots into 5 bundles. We simulated a single incision in the spinal canal via the subdural approach for contralateral C₇ nerve transfer surgery, and performed anterior-root-to-anterior-root anastomosis and posterior-root-to-posterior-root anastomoses on the dorsal side of the spinal cord.

When the C₇ nerve exited the dura mater, the anterior root and the posterior root ran separately. The C₇ nerve had a filiform structure, arranged symmetrically left and right. The root filaments were attached to the connective tissue under the soft membrane, and the length of the root filaments was gradually shortened from top to bottom. The average length of left anterior root decreased from 12.25 ± 0.68 mm to 9.75 ± 1.40 mm, the average length of right anterior root decreased from 12.95 ± 1.49 mm to 10.00 ± 2.00 mm, the average length of left posterior root decreased from 15.63 ± 1.55 mm to 12.38 ± 0.71 mm, and the average length of right posterior root decreased from 15.48 ± 1.37 mm to 12.30 ± 0.90 mm. All 4 specimens completed the simulated anastomosis of C₇ nerve root Nerve fascicle with the assistance of neuroendoscope and microscope, and the anastomosis of the posterior root was one-to-one anastomosis of 1-5 bundles. Cross anastomosis was used for anterior root anastomosis in two specimens, that is, the first bundle on the healthy side was anastomosed with the third bundle on the affected side. In the other two specimens, one-to-one anastomosis of 1-3 bundles was performed. When suturing the arachnoid membrane, there was a tearing phenomenon of the arachnoid membrane, and the dura mater was completely sutured.

From an anatomical perspective, it is feasible to anastomose the healthy C₇ nerve with the affected root filament in the dorsal bundle of the spinal cord with a single incision under the dura mater, providing theoretical and clinical basis for the feasibility of the contralateral C₇ nerve intraspinal transfer surgery.

To investigate the regulatory role of AngiotensinⅡ(AngⅡ)receptor antagonist (Losartan) in the tumor microenvironment of breast cancer brain metastases and the potential mechanism by which it inhibits tumor proliferation.

Western blotting (WB) was used to detect the expression levels of AngⅡ and AngⅡreceptor (AT1R) in the 4T1 breast cancer cell line. The CCK-8 assay was used to evaluate the effects of Control group, Losartan group (Losartan), Paclitaxel group(chemotherapy drug, Paclitaxel), and Combination drug group (Losartan combined with Paclitaxel) on the proliferation of 4T1 breast cancer cells. A 4T1 animal model of breast cancer cerebral metastasis was developed. Randomly, the animals were separated into four groups: Control, Losartan, Paclitaxel, and Combination drug (each n=4). Based on the head MRI results, tumor diameters and the drug effects on tumor growth were monitored. Immunohistochemistry and immunofluorescence staining were used to assess the gene expression of collagen type Ⅰ alpha 1 chain (COL1A1), platelet endothelial cell adhesion molecule (CD31) and hypoxia-inducible factor 1-alpha subunit (HIF-1α) in the tumor microenvironment. This study evaluated the function of Losartan in the tumor microenvironment of brain metastases from breast cancer.

The relative expression of AngⅡ in the 4T1 breast cancer cell line was significantly higher than in the brain tissue of normal rodents (respectively: 0.29±0.07, 0.50±0.11, t=3.28, P=0.017); the 4T1 breast cancer cell line expressed AT1R. The CCK-8 assay revealed a difference in the relative absorbance of the four groups (F=556.40, P<0.001). There was no significant difference between Control group and Losartan group, Paclitaxel group and Combination group (all P>0.05). The MRI results revealed that the tumor size in all four groups grew linearly relative to the size at the time of entry, with a difference between the four groups (F=3.27, P=0.049). After 28 days of medication, compared with the Control group, the maximum tumor diameter of Losartan group was smaller, and that of Combination group was smaller than that of Paclitaxel group, and the differences were statistically significant(both P<0.05). The immunohistochemical staining results showed the positive rates of COL1A1 was significantly different among the four groups (F=64.47, P<0.001). The immunofluorescence staining results showed the positive rates of CD31 and HIF-1α among four groups were statistically significant(all P<0.05).

Ang Ⅱ receptor antagonist enhances the efficacy of chemotherapeutic agents and inhibits tumor cell proliferation by modulating the tumor microenvironment of breast cancer brain metastases, reducing hypoxia, and enhancing intra-tumoral vascular distribution, instead of directly acting on tumor cells.

To explore the role and mechanism of Lnc-CYS1-1 in the glioma malignancy.

A total of 11 patients with glioma (tumor and peritumoral tissues) who underwent surgical treatment at the Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University from October 2020 to February 2021 were retrospectively enrolled into this study. Quantitative real time polymerase chain reaction (qRT-PCR) was performed to detect the expression of Lnc-CYS1-1 in the glioma tissues/cells (U251, A172, LN229, SNB19 and U87) and its distribution in the nucleus and cytoplasm. Location of Lnc-CYS1-1 was identified by fluorescence in situ hybridization (FISH) in U251 cells. The experiment was divided into two groups: Lnc-CYS1-1 siRNA group and NC siRNA group(control group). The glioma cell viability was examined via Cell Counting Kit-8 (CCK8) assay in U251 and SNB19 cells. Cell cycle and apoptosis were analyzed by flowcytometry. Invasive ability was assessed by Transwell assay. RNA pull-down assay and proteomic mass spectrometry were used to confirm the downstream target of Lnc-CYS1-1, which was confirmed by Western blot (WB) and immunohistochemistry. The interaction between Lnc-CYS1-1 and TPM3 was verified by RNA binding protein immunoprecipitation assay (RIP). The expression of TPM3 was evaluated in glioma tissues of different WHO grades from China Glioma Genome Atlas(CGGA) Database and clinical samples. The survival analysis was conducted in the glioma patients with different TPM3 expression.

Lnc-CYS1-1 was overexpressed in glioblastoma tissues and cell lines compared to peritumoral tissue and HEB cells (both P<0.001). Lnc-CYS1-1 was mainly distributed in the cytoplasm of U251 cells, accounting for about 70%, while with the proportion of 30% in the nucleus. The qRT-PCR results showed that the relative expression level of Lnc-CYS1-1 in the Lnc-CYS1-1 siRNA group was significantly decreased compared with the control group in U251 and SNB19 cells (both P<0.05). The CCK8 results revealed that Lnc-CYS1-1 siRNA-treated glioma cells showed a significant decrease in viability than control group cells (all P<0.05) at 48 h and 72 h. The results of flow cytometry showed that the G₀/G₁ ratio and apoptotic rate of glioma cells in the Lnc-CYS1-1 siRNA group were higher than those in the control group (both P<0.05). The results of Transwell experiment revealed that the number of glioma cells through the matrix gel in Lnc-CYS1-1 siRNA group was less than that in control group(both P<0.05). It was also illustrated that TPM3 may be a downstream target of Lnc-CYS1-1 by RNA pull-down experiment and mass spectrometry. The results of the RIP experiment showed that compared with the IgG group, the expression of Lnc-CYS1-1 in the TPM3 immunoprecipitation sample group was significantly increased (P<0.001), indicating a specific interaction between Lnc-CYS1-1 and TPM3. The expression of TPM3 was positively correlated with the grade of glioma. Patients in the high expression group (n=110) of TPM3 had a significantly shorter median survival time compared to the low expression group (n=110) (P<0.001).

The expression of Lnc-CYS1-1 is upregulated in glioma tissues and cells. Knockdown of Lnc-CYS1-1 could significantly inhibit the proliferation and invasion of glioma cells, and induce cell apoptosis. Lnc-CYS1-1 may play a role in the malignant progression of glioma through its interaction with TPM3.

To investigate the effect of isotonic contrast agents with different dilution concentrations on the image quality of high resolution C-arm CT after intracranial Tubridge flow-diverter (FD) implantation in the carotid artery of Bama mini-piglets (experimental pigs).

Nine healthy experimental pigs (3-4 months old) were enrolled and FD was implanted into the left carotid artery of each pig. During high-resolution C-arm CT scanning of the FD implantation area, isotonic contrast agents (iodixanol 320) with dilutions of 10%, 12%, 14%, 16%, and 18% were sequentially injected into the arteries of each experimental pig at a rate of 2 ml/s for a total duration of 22 s and with a total volume of 44 ml. One radiological and one neuro-interventional physician evaluated the quality of the post-processing images (including the visualization of stent, vessel wall and blood vessels) and determined a qualitative score ranging from 1 to 3 points (with lower scores indicating better image quality). Intravascular ultrasound (IVUS) was used to validate the accuracy of FD wall apposition assessment using high-resolution C-arm CT reconstruction images obtained with different contrast agent dilution concentrations. The occurrence of surgery-related complications was observed.

Nine experimental pigs were successfully implanted with FD, with a technical success rate of 100%. After high-resolution C-arm CT scans with contrast agents of dilutions of 10%, 12%, 14%, 16%, and 18%, two physicians showed good consistency in the evaluation of the quality of the post-processing images (Kappa value: 0.76, P<0.05). The image quality scores were 2.33±0.50, 2.06±0.39, 1.72±0.57, 1.11±0.32 and 1.83±0.50 points respectively (P<0.01). Among them, 4, 6, 8, 9, and 7 experimental pigs showed clear display of the apposition of FD to the vessel wall, which was completely consistent with the IVUS evaluation. During the operation, moderate vascular spasm occurred in 3 experimental pigs after contrast agent administration, which improved after heparin administration. No complications such as bleeding at the puncture site, vascular dissection or thrombus shedding were observed post operation.

After Tubridge FD implantation in the experimental pig, high-resolution C-arm CT scan with 16% dilution concentration of iso-osmolar contrast agent show the best image quality, which could clearly display the apposition of FD to the vessel wall.

Turcot syndrome (TS) refers to a hereditary disease that occurs simultaneously or successively with malignant tumors of the central nervous system and colorectal malignant tumors. It usually needs to be diagnosed in combination with medical history and pathology. The 5-year survival rate<5%。 The Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, treated a total of 3 patients with TS from November 2018 to May 2021. All patients underwent craniotomy, total or near-total tumor resection, and postoperative adjuvant chemoradiotherapy. The postoperative pathology confirmed all glioblastoma. One patient had multiple tumor recurrences and died, one survived well 8 months after surgery, and one was lost to follow-up.

Glial ependymal cysts are more common in adults and are usually located in the brain parenchyma adjacent to the ventricles in the frontal or temporal lobes. In March 2022, the Department of Neurotumor Surgery, the First Hospital of Jilin University admitted a child patient with glial ependymal cyst in the anterior pontic cistern. After total cyst resection by craniotomy, the patient's symptoms were completely relieved and there were no new neurological complications.

In recent years, the development of interdisciplinary disciplines of medicine and engineering has led to extensive research and application of surgical robots. Because of its real-time monitoring and imaging, magnetic resonance compatible surgical robots promote the precise and minimally invasive development of surgical robots in neurosurgery, so they are of great value in the field of medical robots, especially in the field of neurosurgery. In this paper, the development process, indications, current classification, limitations and future prospects of MRI compatible surgical robots in neurosurgery are reviewed in order to be helpful for clinical application.

Diffuse midline glioma with H3K27 changes often originates from midline structures of the central nervous system, such as thalamus, brainstem, spinal cord, etc. Diffuse midline gliomas occurring in the pons are referred to as diffuse endophytic pons gliomas (DIPG). The median survival time of DIPG is about 9 to 12 months, the 2-year survival rate is 10% to 25%, and the 5-year survival rate is very poor<H3K27 changes were present in 1% and approximately 80% of children. In recent years, with the development of molecular biology related technologies, targeted therapy and cell therapy, there has been a new understanding of the mechanism of DIPG and the treatment mode. In this paper, the possible pro-tumor mechanisms of DIPG with H3K27 changes in epigenetics, cell metabolism, immune microenvironment, etc. and potential therapeutic targets for these aspects are reviewed, in order to provide assistance for precise clinical treatment.

Dystonia is a dyskinetic disorder in which persistent or intermittent involuntary contractions of muscles cause limb twisting, repetitive movements, or abnormal posture. With the development of gene sequencing technology, researchers have found that genetic factors play an important role in the occurrence and development of dystonia. At present, the treatment options for dystonia are mainly based on personal clinical experience, and there is no effective treatment. The emergence of deep brain electrical stimulation (DBS) provides more options for the treatment of this disease. This article reviews the clinical manifestations of patients with different genotypes of dystonia and the research progress in the treatment of DBS, aiming to explore the effectiveness of DBS in dystonia, with a view to providing individualized treatment options for patients.

Glioblastoma is the most common primary malignant brain tumor in adults. Despite the comprehensive treatment strategy based on surgery, patients had a poor prognosis and their 5-year survival rate<10%。 Exploration of multimodal treatment for glioblastoma has been ongoing, including precision treatment, immunotherapy, chemotherapy and radiotherapy based on molecular characteristics and genomic structure. With the development of science and technology, physical therapy is expected to become an important method for the treatment of glioblastoma. In this paper, the principles and research progress of the main physical therapy modalities of glioblastoma are reviewed.

The incidence of trigeminal neuralgia is about 180/100,000, and its surgical treatment methods mainly include percutaneous microballoon compression of trigeminal ganglion, percutaneous puncture of trigeminal semilunar radiofrequency thermocoagulation damage, trigeminal root microvascular decompression, etc. Patients often have hemodynamic changes without warning during operation, and the mechanism of hemodynamic changes caused by different surgical methods may be different, but the mechanism of this change is still unclear. This paper reviews its characteristics and mechanism research progress, and then puts forward preventive and therapeutic measures.