Volume 39 · Issue 09 · 2023

To investigate the safety and effectiveness of ultrasonic osteotome in the interarticular manipulation of patients with basilar invagination and atlantoaxial dislocation.

A retrospective analysis was conducted on the clinical data of 43 patients diagnosed with basilar invagination combined with atlantoaxial dislocation who underwent interarticular manipulation using ultrasonic osteotome during surgery at the Spine Center, Sanbo Brain Hospital, Capital Medical University from October 2019 to September 2022. Intraoperatively, ultrasonic osteotome (ultrasonic group, 23 cases) and high-speed burr (conventional group, 20 cases) were used for interarticular operation, including excision of articular cartilage and joint remodeling. The time, blood loss, preservation of C₂ nerve root during bilateral joint operation, presence of vertebral artery injury, dural injury, and improvement of symptoms assessed by the Japanese Orthopaedic Association (JOA) score at 6 months postoperatively were documented in both groups.

The surgeries of all 43 patients were successfully completed. In the ultrasonic group, no cases of vertebral artery or dural injury were observed, and the C₂ nerve roots were preserved in all cases. In the conventional group, there was 1 case of intraoperative dural injury and 1 case of C₂ nerve root injury. The JOA scores at 6 months postoperatively increased significantly compared to preoperative scores in both groups (both P<0.001). The ultrasonic group had shorter interarticular operation time (14.15±4.28 min vs. 19.05±4.35 min) and less blood loss [M (Q₁, Q₃): 200 (150, 250) ml vs. 250 (200, 300) ml], with both differences being statistically significant (both P<0.05). However, there were no statistically significant differences in JOA scores at 6 months or the rate of improvement between the two groups (both P>0.05).

The application of ultrasonic osteotome for interarticular manipulation in basilar invagination with atlantoaxial dislocation is a safe and effective method, with shorter operation time and less intraoperative blood loss compared with conventional high-speed burr surgery.

To evaluate the anomalies of V3 in patients with basilar invagination (BI) and atlantoaxial dislocation and to discuss the surgical strategies of BI patients according to V3 anatomy.

The clinical and imaging data of 56 patients with BI and atlantoaxial dislocation who underwent posterior instrumentation surgery of the craniovertebral junction (CVJ) at the Department of Neurosurgery, Xuanwu Hospital of Capital Medical University from January 2017 to January 2019 were retrospectively reviewed. For patients without V3 anomalies, lateral mass screws combined with axial pedicle screws were used for internal fixation. For patients with extraosseous V3 anomalies, occipital screws were used instead of lateral mass screws. For patients with high-riding vertebral artery (HRVA), C₂ laminar screws or isthmus screws were used instead of pedicle screws. X-ray and CT examinations were routinely performed in all patients after surgery to assess the location of internal fixation devices and the occurrence of posterior circulation infarction.

Of the 56 patients, there were 18 cases (32.1%) without any V3 anomalies. There were 20 cases (35.7%) with extraosseous V3 anomalies, including 16 cases of persistent first intersegmental artery (FIA), 2 cases of fenestrated vertebral artery (FVA) and 2 cases of posterior inferior cerebellar artery (PICA) with epidural origin. There were 28 cases (50.0%) of HRVA. There were 10 cases (17.9%) with extraosseous V3 anomalies combined with HRVA. None of the 56 patients had vertebral artery injury during the C₂ screw implantation. A patient with FVA developed massive hemorrhage due to inferior trunk damage during exploration of atlantoaxial joint and implantation of lateral mass screw, and coagulation was performed to stop bleeding during the operation. In all patients, X-ray and CT examinations showed that the screw positions were good, and CT did not show any obvious signs of posterior circulation infarction.

V3 anomalies are common in patients with BI. Therefore, preoperative radiological studies should be performed to identify V3 segment anomalies to reduce the risk of iatrogenic VA injury during posterior CVJ instrumentation. To avoid disastrous complications associated with VA injury, the strategy of posterior CVJ instrumentation surgery should be decided according to the V3 anomalies in patients with BI.

To investigate the therapies for neurosurgical lesions associated with Currarino syndrome (CS) and the outcomes.

A retrospective analysis was conducted on the clinical data of 19 cases of CS admitted to Department of Neurosurgery, the Seventh Medical Center of the PLA General Hospital from October 2013 to September 2020. All operations were performed via the posterior median sacral approach. Based on associated diseases, three kinds of surgical methods were adopted which included teratectomy (11 cases), surgical management of presacral meningocele (12 cases) and lipoma resection (3 cases). The 17 children with tethered cord underwent untethering surgery. Follow-up was performed by outpatient visits or internet to evaluate the improvement of clinical symptoms. Imaging follow-up was used to determine the change of lesions after procedure.

Total resection were achieved in children who underwent neurosurgical treatment (including teratectomy, treatment of presacral mass and sacral dysplasia). total or subtotal resection was achieved in 3 cares of lipoma. Incision infection was observed in 1 child post operation. All patients were followed up for 2 years. At the last follow-up, intractable constipation was relieved in 5 cases and symptoms in the remaining 14 patients remained unchanged. MRI showed that the cystic mass of teratoma disappeared in 10 cases and 1 case had a small amount of residue. The presacral meningocele sac disappeared in 5 cases and shrunk by more than 75% in 7 cases. Lipomas were totally or subtotally removed. All tethered cord were completely released.

Appropriate treatment of neurosurgical diseases associated with CS can lead to satisfactory efficacy and partially relieve the symptoms with few postoperative complications and low rate of recurrence.

To investigate the predictive value of intraoperative direct wave (D wave) monitoring for the outcome of postoperative motor function in patients with intramedullary spinal cord tumors.

A retrospective analysis was conducted on the clinical data of 74 patients with intramedullary spinal cord tumors who were treated at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from May 2021 to August 2022. All patients received intraoperative monitoring of D wave, and the reduction rate of D wave amplitude during operation was documented. The modified McCormick Scale (MMS) was used to evaluate the clinical status of the patients before operation, 1 month and 6 months after operation, and they were divided into new-onset functional impairment group and non-new-onset functional impairment group according to the preoperative and postoperative rating. Univariate and multivariate logistic regression analyses were used to determine the influencing factors of postoperative motor function outcome. Receiver operating characteristic (ROC) curves were drawn and the area under the curve (AUC) was calculated to determine the critical value of D wave and its value in predicting the outcome of postoperative motor function.

Among the 74 patients, total resection was performed in 63 cases and subtotal resection in 11 cases. Intraoperative monitoring revealed a decrease in D-wave amplitude in 46 cases (62.2%) of the patients, with 7 cases (15.2%) exhibiting a decrease of more than 50% in D-wave amplitude. At 1 month postoperatively, there were 54 cases of new-onset functional impairments and 20 cases without new-onset functional impairments. The median intraoperative decrease in D-wave amplitude was 20.2% (Q₁, Q₃: 0, 42.1%) in the new-onset functional impairment group and 4.7% (Q₁, Q₃: 0, 24.2%) in the non-new-onset functional impairment group, with no statistically significant difference (P=0.133). At 6 months postoperatively, there were 11 cases of new-onset functional impairments and 63 cases without new-onset functional impairments. The median intraoperative decrease in D-wave amplitude was 52.2% (Q₁, Q₃: 42.5%, 64.4%) in the new-onset functional impairment group and 6.5% (Q₁, Q₃: 0, 30.3%) in the non-new-onset functional impairment group, with a statistically significant difference (P<0.001). Multivariable logistic regression analysis revealed that the intraoperative decrease in D-wave amplitude was an independent influencing factor for the six-month functional outcome of the patients (OR=1.25, 95%CI: 1.06-1.47, P=0.008). ROC curve analysis showed that the critical threshold for predicting the six-month motor functional outcome based on the decrease in D-wave amplitude was 39.8%, with a sensitivity of 90.9% and specificity of 90.5%.

Intraoperative D-wave monitoring results can effectively predict the six-month motor functional outcome in patients with intramedullary spinal cord tumors. The decrease of D wave amplitude ≥ 40% can serve as an intraoperative warning criterion.

To observe the clinical efficacy of intraoperative spinal angiography-assisted microsurgery in the treatment of spinal dural arteriovenous fistula (SDAVF).

A total of 47 SDAVF patients who were admitted to the Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated of Nanjing University School of Medicine from January 2018 to December 2021 were retrospectively enrolled into this study. All patients underwent digital subtraction angiography (DSA) of spinal cord vessels during the operation to determine the source of the supplying artery, location of the fistula, and draining vein, et al. The fistulas were resected by electrocoagulation. Indocyanine green fluorescein contrast and DSA were used to evaluate the treatment of SDAVF during operation. The spinal cord function was assessed by the modified Aminoff-Logue score (mALS).

All 47 patients underwent the operations successfully. No complications related to spinal cord angiography occurred during the operation, and there was no accidental injury of spinal cord vessels or residual fistula. The postoperative follow-up period was 10.8±4.3 months(3-24 months). Symptoms were improved in 41 cases, not improved in 5 cases, and aggravated in 1 case. The median value of mALS at postoperative follow-up was 2 (1-3) points, which, compared with the preoperative score of 3 (2-4) points, was significantly different (P<0.001). Of the 16 patients with a disease course > 12 months, 5 showed no improvement of mALS; among the 27 patients with a disease duration of 6 to 12 months, 1 patient reported no improvement of mALS; all 4 patients with a disease course of 0 to 6 months reported improvement of mALS; the difference was statistically significant (P=0.024). CT angiography or MR angiography follow-up showed no residual or recurrence of lesions.

Intraoperative spinal cord angiography-assisted microsurgery is safe and effective in the treatment of SDAVF. A long course of SDAVF may affect the improvement of patients′ postoperative symptoms.

To observe the effect of epidural spinal cord electrical stimulation (EES) on some autonomic nervous functions after chronic spinal cord injury (SCI).

The patients with chronic SCI who were treated with EES in the Department of Neurosurgery, General Hospital of Tianjin Medical University from January 2020 to March 2022 were prospectively enrolled into this study. The EES device was implanted in stages, and the EES was turned on the 3rd day after EES implantation, and the test observation was carried out for about 10 days (phase Ⅰ endpoint). Those who wish to continue treatment are placed with a rechargeable permanent stimulator device and evaluated 1 year after surgery (stage Ⅱ endpoint). The spinal cord function was assessed by the American Spinal Injury Association (ASIA) grading standard, and the numeric rating scale (NRS), light touch and acupuncture scores (LT, PP), the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), the modified Ashworth scale (MAS), the neurogenic bladder symptom score (NBSS) and the neurogenic bowl dysfunction (NBD) score were used to assess the effect of EES effect on pain, sensation, muscle tone, defecation and urination, sweating and other autonomic nervous functions. Urinary dynamics and anorectal dynamics were used to assess the defecation and urination function, surface Electromyography (EMG) was used to record the lower limb myoelectric response, and functional near-infrared spectroscopy (fNIRS) was used to assess the lower limb superficial tissue perfusion and oxygen metabolism.

A total of 4 patients were included, all completed Phase Ⅰ assessment, and 2 completed Phase Ⅱ assessment. There was an increase in ASIA grading in 1 patient at the endpoints of stage Ⅰ and stage Ⅱ . At the end point of Phase Ⅰ, all 4 patients achieved various degrees of relief in pain and muscle spasms. NRS decreased from preoperative 6.50 points to 3.00 points, and MAS decreased from 15.25 to 12.87. EMG recorded a significant inhibitory effect of EES on involuntary muscle spasms in the lower limbs. The improvement level of Phase Ⅱ endpoint evaluation remained good. The changes in LT and PP scores were not significant in the endpoint evaluations of stage Ⅰ and stage Ⅱ . At the end point of phase Ⅰ, the NBSS and NBD scores of urination and defecation function in 4 patients decreased from preoperative 42.5 points and 21.00 points to 35.75 points and 17.00 points respectively. Urinary dynamics and anorectal dynamics related indicators have improved to varying degrees. Phase Ⅱ endpoint evaluation further improved urination and bowel functions. In the Phase Ⅰ endpoint observation, the fNIRS results showed that EES significantly increased the hemoglobin (HbT) concentration in the superficial tissues of the lower limbs.

The preliminary study has shown that EES seems helpful for improvement of pain, muscle tension, urination, defecation and tissue perfusion in patients with chronic SCI.

To investigate the clinical effect of Rosa robot-assisted stereotactic aspiration in the treatment of brain stem hemorrhage.

The clinical data of 40 patients with brain stem hemorrhage treated by Rosa robot-assisted stereotaxic aspiration in the Neurosurgery Department of Tianjin First Central Hospital from December 2019 to December 2021 were retrospectively analyzed. Single-target puncture was performed in 24 cases and double-target puncture was performed in 16 cases. Transfrontal approach in supine position was used in 12 cases, subtentorial occipital approach in 20 cases and subtentorial occipital approach in 8 cases. Glasgow outcome scale (GOS) was used to evaluate the outcomes of patients. All patients were followed up for 6 months.

Hematoma was cleared in 7 cases (17.5%) which was revealed by head CT immediately after operation. After urokinase injection, hematoma was mostly cleared within 72 h in 12 cases (30.0%), mostly cleared within 3-7 d in 14 cases (35.0%) and slowly absorbed within 1-4 week in 7 cases (17.5%). The drainage tube of hematoma cavity was removed in all patients within 7 days. There were 22 cases of pneumonia, 21 cases of hypoproteinemia, 17 cases of stress ulcer, 10 cases of deep vein thrombosis, 15 cases of liver, kidney and heart dysfunction. At 6 months post operation, 13 patients (32.5%) died. Among the 27 patients who survived, 17 patients had improved consciousness compared preoperative conditions, including 5 patients who were fully awake and 12 patients who showed minimally conscious state (MCS). There were 10 cases of vegetative state. GOS included 13 cases of grade Ⅰ, 10 cases of grade Ⅱ, 12 cases of grade Ⅲ, and 5 cases of grade Ⅳ.

Rosa robot-assisted stereotactic aspiration can improve the survival rate of patients with brain stem hemorrhage.

To evaluate the role of arterial spin labelling (ASL) imaging in the preoperative evaluation of drug-resistant focal epilepsy.

A retrospective analysis was conducted on the clinical data of patients with drug-resistant focal epilepsy who underwent preoperative evaluation in Neurosurgery Department of Yuquan Hospital, Tsinghua University from January 2022 to September 2022. A total of 29 patients were included, of which 26 were children. The epileptogenic zone (EZ) was evaluated preoperatively based on clinical data, video electroencephalography (VEEG), brain structural MRI, and positron emission tomography (PET)-CT. All patients underwent interictal ASL examination, and qualitative analysis of cerebral blood flow (CBF) images obtained by ASL was performed by visual reading to determine whether there was abnormal perfusion and distribution patterns. The consistency between abnormal perfusion sites and EZ confirmed by multidisciplinary meetings and SEEG results was analyzed.

Among 29 patients, EZ was identified in 28 (97%) patients, and 25 of them underwent surgical treatment. EZ of 1 (3%) patient was not clear and received medication. Of the 29 patients, 26 (90%) had abnormal CBF imaging, including 19 (66%) with local hypoperfusion, 5 (17%) with local hyperperfusion and 2 (7%) with both local hypoperfusion and hyperperfusion areas, and 3 (10%) with negative results. Local hyperperfusion was found in 3 of the 4 patients with interictal near-continuous focal epileptiform discharges, while among the 25 patients without near-continuous epileptiform discharges, 4 patients had local hyperperfusion, and the difference was statistically significant (P=0.034). Of the 19 patients with focal hypoperfusion on CBF imaging, 18 cases showed consistency between hypoperfusion site with the EZ determined by presurgical evaluation and 1 showed partial consistent. Of the 7 patients with hyperperfusion on CBF imaging, 5 showed consistency between hyperperfusion site with the EZ determined by presurgical evaluation, 1 showed partial consistent, and 1 showed inconsistency. There was no significant difference in the consistency rate between abnormal CBF (hypoperfusion or hyperperfusion) site and EZ determined in presurgical evaluation (P=0.167). Among the 25 patients who underwent surgical treatment, 22 (88%) showed consistency between the abnormal perfusion sites and those resected or ablated during surgery. The median follow-up time of the patients was 10 months (1-12 months). Among the 25 cases treated with surgery, none had seizures after operation.

Interictal ASL could facilitate the identification of EZ and has certain localizing value in the preoperative evaluation.

To explore the risk factors of cerebral infarction after bypass surgery in adult patients with moyamoya disease (MMD), and to determine the parameters that can predict the occurrence of cerebral infarction post operation.

The clinical data of 83 adult MMD patients admitted to the Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University from September 2019 to December 2022 were retrospectively analyzed. All patients were treated with combined bypass surgery (superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-myo-synangiosis). Based on whether there was a new-onset cerebral infarction within 1 week after operation, all patients were divided into cerebral infarction group and non-cerebral infarction group. Univariate analysis and multivariate logistic regression analyses were used to explore the risk factors of postoperative cerebral infarction. Furthermore, the independent risk factors were analyzed by receiver operating characteristic (ROC) curve to determine the best threshold, test sensitivity and specificity for predicting the occurrence of cerebral infarction.

Among the 83 patients, 11 cases had new cerebral infarction and 72 cases had no new cerebral infarction within 1 week after operation. There were no significant differences in age, sex, history of hypertension, hyperlipidemia, history of smoking, type of onset, Suzuki stage, involvement of posterior circulation or the side of surgical intervention between the two groups (all P>0.05). There were significant differences in preoperative CT perfusion parameters between cerebral infarction group and non-infarction group, including relative cerebral blood volume (median)(1.18 vs. 0.94, P=0.002), relative mean transit time (2.79±0.58 vs. 1.66±0.69, P<0.001) and relative time to maximum of the residual function (median, rTmax)(3.18 vs. 1.59, P<0.001), whereas the difference between the two groups in rCBF was not significant (P=0.121). Multivariate logistic regression analysis showed that rTmax was the only independent risk factor for postoperative cerebral infarction (OR=36.61, 95%CI: 1.95-687.23, P=0.016). ROC curve analysis showed that the area under the curve of rTmax for predicting the occurrence of postoperative cerebral infarction was 0.970 (95% CI: 0.93-1.00, P<0.001); the optimal threshold, sensitivity and specificity were 2.104, 1.000 and 0.847 respectively.

The elevated rTmax may be used to predict the occurrence of cerebral infarction after bypass surgery in adult MMD with high sensitivity.

To compare the clinical effects of nuchal ligamentum fascia and artificial dura mater on dural repair in posterior fossa tumor via suboccipital posterior midline approach in children.

The clinical data of 63 children who underwent intracranial tumor resection via suboccipital posterior midline approach in the Department of Neurosurgery, the Second Affiliated Hospital of Air Force Medical University from January 2017 to May 2022 were retrospectively analyzed. Among them, artificial dura mater was used in 30 cases (group A) and nuchal ligament fascia in 33 cases (group B). The clinical data, postoperative complications and efficacy of the two groups were compared.

The dura suture repair time in the B group was (11.2 ± 1.3)min, and there was a statistically significant difference compared to the A group (15.5 ± 1.7) min (P<0.05). After operation, there were 4 cases (13.3%) of pseudomeningocele, 5 cases (16.7%) of cerebrospinal fluid leakage, and 4 cases (13.3%) of intracranial infection in group A, and 1 case (3.0%) of intracranial infection in group B, and there was no pseudomeningocele or cerebrospinal fluid leakage in group B. The incidence of pseudomeningocele and cerebrospinal fluid leakage was statistically significant between the two groups (both P<0.05). The length of hospital stay and the total cost of hospitalization in group B were lower than those in group A, and the differences were statistically significant (both P<0.05). Sixty-three children were followed up for 6-12 months, and none of them had pseudomeningocele or cerebrospinal fluid leakage.

Compared with the use of artificial dura, the use of nuchal ligament fascia repair in children undergoing posterior fossa tumor resection via suboccipital posterior midline approach can reduce the incidence of complications such as pseudomeningocele and cerebrospinal fluid leak.

To preliminarily analyze the safety and efficacy of the modified dural perforation and sealing method in deep brain stimulation (DBS) for Parkinson′s disease (PD) and its effect on the improvement of intracranial air (ICA) and the correlation with the factors that may affect .bilateral total intracranial air (TICA ).

A retrospective analysis was performed on the clinical data of 46 patients with PD who underwent DBS surgery in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021. All patients were implanted with bilateral intracranial electrodes using modified dural perforation and sealing methods, of which 6 patients underwent local anesthesia and 40 patients underwent general anesthesia. After the electrode implantation, head CT examination was performed and 3D slicer software was used for post-processing of images to calculate the volume of ICA. The difference in ICA volume on two sides and the factors affecting were analyzed.The correlation with possible TICA factors was analyzed by Pearson or Spearson correlation coefficient method.

All DBS surgeries were successfully completed. A total of 92 electrodes in 46 cases were implanted successfully. There were no postoperative complications such as intracranial hemorrhage. Operation time related to bilateral electrode implantation for patients under local anesthesia and general anesthesia was 153.33 ± 42.74 minutes and 89.75 ± 28.15 minutes, respectively, with statistically significant differences (t=4.82, P < 0.001). Of the 46 patients, 26 (56.5%) had no ICA and 20 (43.5%) had a TICA volume [M (Q₁, Q₃)] of 0.38 (0.13, 2.10) cm³. Among them, TICA volume of < 1 cm³ was observed in 12 cases, 1-5 cm³ in 5 cases, >5-10 cm³ in 1 case, and >10 cm³ in 2 cases. The volume [M (Q₁, Q₃)] of left and right intracranial ICA in patients with ICA was 0.15(0.01, 1.29) cm³ and 0.05(0, 1.67) cm³, respectively. ICA volume [M (Q₁, Q₃)] of the first and second choice side was 0.05 (0, 0.36) cm³ and 0.11 (0, 1.86) cm³, respectively, with no statistical significance (both P > 0.05). The incidence of ICA was 52.2% (12/23) and 34.8% (8/23), respectively, with or without microelectrode recording, and the difference was not statistically significant(P=0.373). The correlation analysis of ICA patients showed that age, sex, anesthesia method and operation time were not correlated with TICA volume (all P > 0.05). The medical history was negatively correlated with TICA volume (P = 0.027).

The modified dural perforation and sealing method in patients with PD can decrease the occurrence of intraoperative pneumocephalus and postoperative complications in DBS, which is a safe and effective method, and the volume of TICA in patients with ICA may be related to their disease course.

To investigate the potential role of a novel type of nerve scaffolds in the recovery of nerve function following schwannoma resection.

Sprague-Dawley rats were used in this study. Rats′ right sciatic nerves were injected with RT4 cells to generate a model for schwannomas, then tumors were removed and nerve scaffolds were implanted at the site of nerve injury. Rats were randomly divided into 3 groups (n=4 each): surgical excision alone group (no scaffold was implanted after tumor excision), commercial scaffold group (commercial scaffolds were implanted after tumor excision) and novel scaffold group (novel scaffolds were implanted after tumor excision). The area of foot ulcers was measured to determine the nutritional status of distal end of limbs on the effected side. Comprehensive gait analysis was used to evaluate coordination of limb movements and stability during walking. Motor evoked potentials in sciatic nerve before and after operation were recorded to observe the change of electrophysiological indexes. The hematoxylin and eosin (HE) staining techniques were used to compare the neurological recovery in histology of the three groups of rats. Comprehensive evaluation of neural function recovery was conducted based on all results.

Four weeks after nerve scaffold implantation, the area of foot ulcers in the novel scaffold group (0±0 mm²) was smaller than that in the commercial scaffold group (6.0±3.8 mm²) and the surgical excision group (23.5±7.2 mm²) (both P<0.05). The difference in sciatic nerve action potential amplitude before nerve scaffolds implantation was not statistically significant among the three groups (P>0.05). At 4 weeks after nerve scaffold implantation, the action potential amplitude was higher in the novel scaffold group (7.15±0.74 mV) than in the commercial scaffold group (4.38±0.51 mV) and the surgical excision alone group (1.74±0.40 mV) (both P<0.001). The improvement in hip and ankle joint activity angle was more obvious in novel scaffold group than the other two groups at 4 weeks after nerve scaffold implantation (both P<0.05), which indicated that the novel scaffold group had better limb coordination and stability during walking. HE staining results showed that nerve fiber repair was more significant in the novel scaffold group 4 weeks after implantation and no nerve sheath tumor recurrence was found.

The novel nerve scaffolds have a better effect on nerve function recovery than commercial scaffolds and then can provide a new treatment strategy for postoperative nerve function recovery in patients with schwannoma.

To evaluate the effect of PFKFB3/HMGB1 signal pathway activated by glycolysis of microglia activation on vascular cognitive impairment (VCI) in rats.

The model of vascular cognitive impairment (VCI) was established by permanent bilateral common carotid artery occlusion in 48 Sprague-Dawley male rats. The rats were randomly divided into 4 groups: sham group, VCI group, VCI + PFKFB3 inhibitor 3PO group (VCI + 3PO group) and VCI + glycolytic agonist DMOG group (VCI + DMOG group) with 12 rats in each group. The cognitive function of rats was evaluated by conditioned fear test. The expressions of neurofilament light chain protein (NFL), S100 calcium binding protein-β (S100-β), lactic acid (Lac), chemokine ligand 2 (CCL2), interleukin-6 (IL-6) and high mobility group box protein 1 (HMGB1) in serum and hippocampus were detected by enzyme-linked immunosorbent assay (ELISA). Western blot (WB) was used to detect the expression of ionized calcium binding adapter molecule 1 (Iba1), PFKFB3, AMP-activated protein kinase α (AMPKα), NOD-like receptor thermoprotein domain associated protein 3 (NLRP3) and Caspase-3 protein. The degeneration of hippocampal neurons was evaluated by hematoxylin-eosin (HE) staining, and the apoptosis of hippocampal neurons was evaluated by TUNEL staining.

The cognitive function and the expression of NFL, S100-β in blood, the expression of HMGB1, Lac, CCL2, IL-6, Iba1, PFKFB3, AMPKα, NLRP3 and Caspase-3 in hippocampal tissues, neuronal degeneration and apoptosis among the 4 groups showed significant differences (all P<0.05). Compared with the sham group, the cognitive function decreased and the expression of NFL, S100-β, Lac, CCL2, HMGB1, PFKFB3, Iba1, NLRP3 and Caspase-3 increased in the VCI group, while the expression of AMPKα decreased and the neuron degeneration and apoptosis increased in VCI group, and the differences were statistically significant (all P<0.05). Compared with the VCI group, the cognitive impairment of VCI + 3PO group was improved, the cognitive impairment of VCI + DMOG group was aggravated, and the expression of NFL, S100-β, Lac, CCL2 and HMGB1 decreased in VCI + 3PO group and increased in VCI + DMOG group. The expression of PFKFB3, Iba1, NLRP3 and Caspase-3 decreased in VCI + 3PO group, while the expression of PFKFB3, Iba1, NLRP3 and Caspase-3 increased and the expression of AMPKα decreased in VCI + DMOG group. The degeneration and apoptosis of neurons in VCI + 3PO group decreased, while the degeneration and apoptosis of neurons in VCI + DMOG group increased, and the differences were statistically significant (all P<0.05).

The enhancement of key glycolytic enzyme PFKFB3 in microglia activation could induce central inflammation and upregulate the expression of NLRP3, leading to neuronal injury, degeneration and apoptosis, and aggravating vascular cognitive dysfunction in rats, which may be related to the increase of pro-inflammatory factor HMGB1 in the hippocampus.

Pituitary blastoma is a rare primitive malignant embryonic tumor of the pituitary gland, which mainly occurs in infants and young children under 2 years of age, and is slightly more common in women. At present, there is no standard treatment, mainly surgical resection, and postoperative adjuvant radiotherapy and chemotherapy; Total surgical resection helps to prolong the survival cycle; The overall prognosis is poor. In August 2018, the Department of Neurosurgery of Pediatric Hospital of Fudan University treated a child with pituitary blastoma. Craniotomy was performed to completely remove the tumor. The postoperative pathology and tumor molecular detection results confirmed that it was pituitary blastoma. There was no recurrence or dissemination of tumor on MRI 3 months after operation, and he died due to severe infection after chemotherapy.

Primary oblique giant cell tumor of bone is extremely rare and easily misdiagnosed. In January 2021, the Department of Neurosurgery of the Second Affiliated Hospital of Jiaxing University treated a case of giant cell tumor of slope bone. The patient presented with headache with diplopia. The MRI of the skull showed that the slope of the skull base occupied space. The initial diagnosis was chondrosarcoma, which was partially resected by surgery. The pathological results confirmed that it was giant cell tumor of bone. The lesion increased 1 year after surgery with intracranial metastasis. The patient died 1.5 years after surgery.

Primary solitary plasmacytoma and amyloid tumor of the skull are rare clinical diseases. A patient reported in this article came to the doctor with huge space-occupying lesions in the frontal, temporal, parietal and occipital regions found by accidental physical examination. The clinical manifestations were atypical, the imaging findings were specific, and the preoperative diagnosis was uncertain. The lesions were totally removed by surgery, and the postoperative pathological examination was diagnosed as plasmacytoma combined with amyloidoma. After radiotherapy, he was discharged from hospital with good prognosis.

Tethered spinal cord is one of the main causes of syringomyelia. The syringomyelia is mostly localized at the end of the spinal cord, and rarely progresses upward and involves the cervical and thoracic segments. In January 2016 and August 2020, the Department of Neurosurgery of Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine treated two children with terminal filament traction combined with total syringomyelia. They underwent tethered cord release. Intraoperative spinal cord was low and terminal filament tension was high. The syringomyelia was significantly reduced in 2 cases after operation, and the total syringomyelia was significantly improved by MRI.

Cavernous malformations of the internal auditory tract are rare in clinical practice, and originate from the vascular plexus around the Scarpa ganglion of the internal auditory tract, which is easy to invade the nerves and cause corresponding symptoms. In November 2021, a patient with cavernous malformation of the internal auditory tract with ipsilateral hearing loss as clinical manifestation was admitted to the Department of Neurosurgery of the 960th Hospital of the Joint Logistics Support Force of the People's Liberation Army. The lesion was resected under multimodal guided neuroendoscopy. Postoperative re-imaging showed that the lesion was totally resected without facial paralysis and other complications.

Glioblastoma is the most common primary intracranial malignancy in adults. Glioblastoma is characterized by invasive growth, strong heterogeneity and easy recurrence, which makes its treatment full of challenges. Local treatment is a hot research topic in recent years. It is expected to improve the prognosis of patients with glioblastoma by directly treating tumors and tumor cavities. This article mainly focuses on the intraoperative treatment of glioblastoma, local infusion of chemotherapeutic drugs and local immune cell therapy.

Chordoma is a bone malignant tumor originating from the remnant tissue of the chorda, with high metastasis and high recurrence rate, and its pathogenesis is still unknown. In recent years, it has been found that miRNA can exhibit specific expression in chordoma, and can change the biological behavior of chordoma by changing the expression of corresponding miRNA. This article reviews the role of miRNA in the development of chordoma, its impact on the prognosis of patients, and the research progress in gene therapy, and looks forward to its research direction, in order to provide help for the treatment of this disease.

Temporal lobe epilepsy is the most common focal epilepsy. Traditional surgical methods have relatively good therapeutic effects in the treatment of refractory temporal lobe epilepsy, but they may cause damage to patients' cognitive and other functions after operation, and patients' acceptance is low. Magnetic resonance-guided laser interstitial hyperthermia technology is an effective means that can achieve accurate and minimally invasive damage to epileptogenic areas in recent years, and provides a brand-new choice for many patients who are unwilling to undergo craniotomy. This article reviews the research progress of magnetic resonance guided laser interstitial hyperthermia in the treatment of refractory temporal lobe epilepsy, in order to provide help for the treatment of this disease.

Fourth ventricular hydrocephalus is a rare type of obstructive hydrocephalus in the nervous system, and timely and accurate diagnosis and treatment can avoid irreversible brain damage. Advances in cerebrospinal fluid dynamic imaging technology have improved people's understanding and diagnosis of fourth ventricular hydrocephalus. Traditional surgical methods include craniotomy, recanalization of the fourth ventricular outflow tract, ventricular-peritoneal shunt, etc. In recent years, with the development of soft neuroendoscopic technique, neuroendoscopic third ventriculostomy and recanalization of fourth ventricular outflow tract have achieved good results in the treatment of fourth ventricular hydrocephalus. However, the above studies are limited to single case or multiple case series reported studies, and the pathogenesis of the disease is still unclear, and the surgical indications and treatment methods are still controversial. Therefore, this paper summarizes the research progress of the diagnosis and treatment of fourth ventricular hydrocephalus by searching the relevant literature on the diagnosis and treatment of this disease.