Volume 39 · Issue 10 · 2023

In the surgical diagnosis and treatment of intracranial arteriovenous malformation (AVM), individualized selection of appropriate imaging evaluation methods and treatment decisions are crucial. How to detect acute ruptured intracranial AVM lesions as early as possible, and how to accurately assess the bleeding risk of unruptured AVM, so as to formulate surgical treatment strategies are the key in clinical diagnosis and treatment. In recent years, the progress of imaging technology and the development of artificial intelligence have had an important impact on the surgical diagnosis and treatment of intracranial AVM. In this paper, the imaging evaluation methods, surgical treatment schemes and related new ideas and methods of intracranial AVM are discussed.

To explore the therapeutic effect and clinical experience of microsurgery in the treatment of patients with multiple intracranial aneurysms (MIA) aged 60 and over.

We retrospectively analyzed the clinical data of 111 elderly patients with MIA who underwent microsurgery in the Department of Neurosurgery, Affiliated Hospital of Qingdao University from December 1997 to December 2021. Among all patients, each of 95 patients had 2 aneurysms, each of 14 had 3 aneurysms, 1 patient had 4 aneurysms, and 1 patient had 5 aneurysms. There were a total of 111 offending aneurysms and 130 non-offending aneurysms. According to the location, size and shape of aneurysms, 101 patients underwent one-stage surgery via unilateral pterional approach, 7 via coronal approach, and 3 underwent staged surgery for aneurysm clipping. Postoperative imaging follow-up was used to evaluate the aneurysm clipping. The Glasgow Outcome Scale (GOS) was used to evaluate the patient′s outcomes.

Among 241 aneurysms in 111 patients, 216 were completely clipped which included 111 offending aneurysms and 105 non-offending aneurysms. Among the 25 non-offending aneurysms, 2 were encapsulated with autologous fascia and fixed with bioglue, 2 were clipped after encapsulation, 2 underwent preoperative intravascular embolization, and 19 cases underwent no particular treatment. A total of 22 patients (19.8%) experienced postoperative complications, including 2(1.8%) cases of severe disability, 3(2.7%) cases of persistent vegetative state and 3 (2.7%) cases of death. Fifty-three patients received imaging follow-up, and the follow-up time [M (Q₁, Q₃)] was 8 (3, 15) months. No recurrence of aneurysm was found. All 108 patients received clinical follow-up, and the follow-up time [M (Q₁, Q₃)] was 23.5 (8.0, 56.5) months. There were 103 cases with good outcomes (GOS grade Ⅳ to Ⅴ) and 5 cases with poor outcomes (GOS grade Ⅰ to Ⅲ), all of which 2 cases were severe disability and 3 cases were persistent vegetative state.

Choosing an appropriate microsurgical approach to treat MIA in the elderly is helpful in reducing postoperative complications and has low disability and mortality rates, making it an effective treatment method.

To analyze the safety and efficacy of endovascular treatment in elderly (≥80 years old) patients with acute large vessel occlusion stroke(ALVOS), and to explore the relevant factors affecting the outcome.

A retrospective analysis was conducted on the clinical data of 68 elderly patients with ALVOS who underwent endovascular treatment in the Department of Neurological Intervention, Zhengzhou Central Hospital of Zhengzhou University from June 2017 to December 2021. Based on the modified Rankin scale (mRS) scores at 3 months after surgery, all patients were divided into good outcome group (mRS<3 points) and poor outcome group (mRS≥3 points). The baseline data, clinical characteristics, and treatment of the two groups were analyzed using univariate analysis. Factors with P<0.05 were incorporated into a multivariate logistic regression analysis model. Forward stepwise regression was used to obtain independent predictors of poor outcome in elderly patients. We plotted the receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC) to determine the critical value of prognosis and its predictive efficacy.

The endovascular procedures of 68 patients were successfully completed. In this series, 53 patients (77.9%) had successful revascularization, 41 patients (60.3%) experienced pulmonary infection, 4 patients (5.9%) experienced thrombus escape, 17 patients (25.0%) had sICH, and 19 patients (27.9%) died after surgery. There were 29 cases (42.6%) in the group with good outcome and 39 cases (57.4%) reported poor outcome. The results of two sets of univariate analysis showed that there were statistically significant differences in atrial fibrillation, preoperative NIHSS score, preoperative intravenous thrombolysis, intraoperative arterial thrombolysis, intraoperative suction coordination, intraoperative stent thrombectomy frequency, treatment method, time window (onset to surgery time >6 hours), and successful vascular recanalization (all P<0.05). The results of multivariate logistic regression analysis showed that the frequency of intraoperative stent thrombectomy, preoperative NIHSS score, and vascular recanalization were independent influencing factors for poor outcomes of patients (all P<0.05). Multifactor ROC curve results for predicting poor prognosis at 3 months after surgery was 0.64, the maximum value of the Jordan index was 0.73, the sensitivity was 79.5%, the specificity was 93.1%, and the AUC value was 0.92 (95%CI: 0.86-0.98, P<0.001); The critical value of preoperative NIHSS score for predicting poor prognosis at 3 months after surgery was 14.50, the maximum value of the Jordan index was 0.48, the sensitivity was 82.1%, the specificity was 65.5%, and the AUC value was 0.78 (95%CI: 0.67-0.90, P<0.001).

For elderly patients with ALVOS after endovascular treatment, attention should be paid to the occurrence of complications such as postoperative neurological dysfunction, sICH, and death. Endovascular treatment should be individually selected based on the preoperative NIHSS score. The number of stent thrombectomy procedure should be minimized during surgery to achieve recanalization of occluded blood vessels, which can benefit patients.

To analyze the clinical characteristics, etiologies and outcomes of cerebral venous sinus thrombosis (CVST) in children.

A total of 20 children with CVST were admitted to the Department of Neurosurgery, Children′s Hospital of Nanjing Medical University from March 2019 to December 2022. All patients were given subcutaneous injection of low-molecular-weight heparin after diagnosis (1 000 IU/10 kg, 2 times/d) for a total of 15 days, warfarin was simultaneously administered on days 12-15, the drug dosage was adjusted according to the international standardized ratio (maintained at 2-3), and the medication time of warfarin was based on different etiologies. We retrospectively analyzed the clinical manifestations, etiologies, radiologic imaging, laboratory data, treatment and anticoagulant efficacy.

The median time from onset to treatment in 20 children was 5.5 d (0.5-17.0 d). Among the patients, headache was reported as the main clinical manifestation in 14 cases, fever in 4 cases, epileptic seizure in 1 case and hemiplegia in 1 case. Modified Rankin scale score (mRS) before treatment was 1 point in 17 cases, 3 points in 1 case, 4 points in 2 cases. In this series, the lesion was located in the transverse-sigmoid sinus in 15 cases, in the superior sagittal sinus in 5 cases including 3 with involvement of cortical veins. The etiological factor of 13 children was otomastoiditis and their lesions were all located in the transverse-sigmoid sinus. Non-infectious etiological factors were reported in 7 cases including 2 cases of leukemia, 1 case of ulcerative colitis, 1 case of TBHB gene mutation, 1 case of traumatic brain injury, 1 case of systemic lupus erythematosus and 1 case with unknown etiology. In 5 cases, the lesions were located in the superior sagittal sinus, of which 3 cases were complicated with cerebral edema and bleeding transformation. Out of 20 children, 8 reported the level of D-dimer ≥ 500 ng/ml before treatment. The median follow-up time of 20 children was 12.5 months (6-51 months). One case died due to systemic lupus erythematosus encephalopathy and multiple organ failure. By the end of follow-up, there were 18 cases with mRS score of 0 and 1 case with mRS score of 2. At 3 months post treatment, MRI venography showed that all affected sites of venous sinus thrombosis were reopened and a 6-month follow-up showed no recurrence.

The etiology of CVST in children is complex and otomastoiditis is the most common risk factor. The lesion is mainly located in the transverse-sigmoid sinus. Active anticoagulant therapy is safe and effective and most children have favorable clinical outcomes.

To investigate the clinical characteristics and outcomes of patients with hypertensive cerebral hemorrhage in the population of long-term residents and sojourners living in the plateau area.

The clinical data of 106 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery of Lhasa People′s Hospital of Tibet Autonomous Region from September 2020 to October 2022 were retrospectively analyzed. Among them, 70 patients lived in the plateau area for a long time (long-term residents group) and 36 patients migrated to the Tibet Autonomous Region (sojourners group). The differences in demographic data, history of hypertension or diabetes, duration of hypertension, hematoma volume, laboratory indexes, therapies, length of hospitalization and outcomes of the two groups were compared.

The sojourners group had a lower age (54.4±7.3 years vs. 63.8±12.0 years, t=-4.28, P=0.001), a lower proportion of previous hypertension [75.0% (27/36) vs. 95.7% (67/70), χ²=2.58, P=0.001], a shorter duration of hypertension [proportion of patients with disease duration longer than 5 years: 22.2% (8/36) vs. 42.9% (30/70), χ²=2.82, P=0.006], a lower proportion of brainstem hemorrhage [13.9% (5/36) vs. 7.1% (5/70), χ²=2.37, P=0.012], a higher proportion of cerebral lobe hemorrhage [13.9% (5/36) vs. 25.7% (18/70), χ²=3.58, P=0.039], a higher blood hemoglobin level (185.6±30.0 g/L vs. 166.8±31.1 g/L, t=-3.03, P=0.003)and a shorter length of hospital stay (12.9±8.9 d vs. 18.4±14.2 d, t=2.43, P=0.017)compared with the long-term residents group. At 1 and 3 months after discharge, the median modified Rankin scale score in the sojourners group (1 point at both time points) was lower than that in the long-term residents(2 points at both time points) (both P<0.05). There were no significant differences in gender, blood pressure or hematoma volume at admission (all P>0.05).

Preliminary results showed that hypertensive intracerebral hemorrhage occurs earlier in sojourners than in long-term residents, while the overall outcome of sojourners seems better.

To examine the efficacy and safety of pipeline embolization devices (PED) for the treatment of large and giant intracranial dissecting aneurysms.

Clinical and imaging data of patients who were treated with PED in 14 clinical centers including Beijing Tiantan Hospital Affiliated to Capital Medical University from November 2014 to October 2019 were collected for retrospective analysis. Patients who were diagnosed with large (15-<25 mm) or giant unruptured dissecting aneurysms (≥25 mm) were extracted from the medical records, and clinical characteristics and treatment exposure were summarized. Immediate aneurysm occlusion rates were assessed using the O′Kelly-Marotta grading scale (OKM) and treatment outcome of patients were evaluated using imaging results and modified Rankin Scale (mRS) scores at clinical follow-up.

A total of 36 aneurysms in 36 patients were treated and 44 PEDs were successfully placed. The patients treated with PED alone or PED combined with coil embolization accounted for 50.0% (18/36) each, and 7 patients (19.4%) underwent surgery using two or more stents. All stents (100.0%, 44/44) had good wall adherence while the rate of successfully deployment after adjustment was 88.9% (32/36). Immediate postprocedural angiography indicated OKM grade A in 20 patients (55.6%), grade B in 12 (33.3%), grade C in 3 (8.3%) and grade D in 1 (2.8%). Among 36 patients, 1 (2.8%) had peri-procedural ischemic complication and 1(2.8%) died. Clinical follow-up was completed in the remaining 35 patients and imaging follow-up in 28 patients (36 aneurysms). The follow-up time ranged from 3 to 24 months, with an average of 11.7±5.3 months. A total of 31 patients (86.1%) had good neurological recovery (mRS score: 0-1). The OKM grade D rate was 92.9%(26/28). 1 case had recurrence. The overall complication rate and mortality rate were 11.1% (4/36) and 5.6% (2/36) respectively.

PED may be an efficient and safe treatment for large and giant dissecting aneurysms and good clinical outcomes can be achieved after short-term or medium-term treatment.

To explore the key imaging features associated with the presence of epilepsy in patients with intracranial arteriovenous malformations (AVMs) using machine learning algorithms and Shapley additive explanation (SHAP) method.

A total of 271 patients with intracranial AVMs admitted to the Neurosurgery Departments of four centers including Beijing Hospital (134 patients), Beijing Tiantan Hospital of Capital Medical University (100 patients), Taiyuan Central Hospital (20 patients) and Zhumadian Central Hospital (17 patients) from January 2022 to January 2023 were retrospectively enrolled into this study. Thirty-one patients had the initial symptom of epileptic seizure (epilepsy group) and 62 patients (control group) were included in the proportion of 2 ∶1 by using the propensity score method. Traditional imaging and morphological features of lesions such as volume, surface area, mean density, roundness, flatness, elongation and location were compared between the two groups based on CT angiography data. While the radiomic features of the lesions were extracted, and a machine-learning model was built based on XGBoost. The performance of the model was evaluated by the area under the receiver operating characteristic curve (ROC) and the SHAP method was applied for assessing the importance of each feature.

There were 5 cases (16.1%) of lesion located in the temporal lobe in the epilepsy group and 19 cases (30.6%) of lesion located in the temporal lobe in the control group, and the difference between the two groups was not statistically significant (χ²=1.42, P=0.208). There were no significant difference in volume, surface area, mean density, roundness, flatness, or elongation of the lesions between the two groups (all P>0.05). Radiomics features were downscaled by L1 regularization and 6 features were finally included, which were incorporated into the XGBoost model together with traditional risk factors and morphological features. The area under the ROC was 1.00 in training set and 0.80 in the independent test set. The results of the SHAP analysis showed that 5 features of epilepsy associated with intracranial AVMs, which included lesions with higher elongation length, higher flatness, lower mean density, being located in the temporal lobe and lower kurtosis and other 3 radiomics features had moderate or large contribution to the model.

Patients with intracranial AVMs associated with epilepsy have significant traditional imaging, morphological and radiomic features. Among them, flatness, elongation, mean density, location in the temporal lobe and kurtosis are the five most important features of epilepsy-relevant imaging features.

To evaluate the first pass effect (FPE) and prognosis factors of mechanical thrombectomy in patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO).

We retrospectively analyzed the clinical data of 197 patients with BAO-AIS who underwent mechanical thrombectomy treatment at the Cerebrovascular Center of Henan Provincial People′s Hospital from June 2016 to June 2022. According to whether FPE was achieved, patients were divided into FPE group and non-FPE group, and univariate analysis and multivariate logistic regression analyses(forward method) were performed to ascertain the involved factors of FPE. According to the modified Rankin scale score (mRS) at 90 days after surgery, patients were divided into good outcome group (mRS≤3) and poor outcome group (mRS>3). Univariate analysis and multivariate logistic regression analyses (forward method) were also performed to evaluate the involved factors of prognosis.

Compared with the non-FPE group (133 cases), the FPE group (64 cases) had higher proportions of female and cardioembolic stroke pathogenesis, lower admission NIHSS scores, higher posterior circulation-the Alberta stroke program early CT score (pc-ASPECTS) and the basilar artery on computed tomography angiography (BATMAN) scores, higher proportions of patients with basilar artery upside occlusion and undergoing preferred thrombus aspiration. Those differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that female (OR=2.27, 95%CI: 1.08-4.79), NIHSS score at admission (OR=0.93, 95%CI: 0.89-0.98), pathogenesis of cardioembolic stroke (OR=2.12, 95%CI: 1.04-4.31), basilar artery upside occlusion (OR=2.41, 95%CI: 1.23-4.72) and preferred thrombus aspiration (OR=2.92, 95%CI: 1.46-5.83) were the involved factors of FPE (all P<0.05). Compared with the group with poor outcome (79 cases), the group with good outcome (118 cases) had lower NIHSS scores, higher pc-ASPECTS and BATMAN scores at admission, a higher proportion of cardioembolic stroke pathogenesis, FPE and successful reperfusion, shorter puncture to reperfusion time, and a lower proportion of symptomatic intracerebral hemorrhage during the perioperative period. Those differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that NIHSS score at admission (OR=1.09, 95%CI: 1.03-1.14) and FPE (OR=0.08, 95%CI: 0.04-0.18) were related factors to clinical outcome at 90 days after surgery (all P<0.05).

Among patients with BAO-AIS treated with mechanical thrombectomy, female, lower NIHSS scores at admission, pathogenesis of cardiogenic embolic stroke, basilar artery upside occlusion and preferred thrombus aspiration are associated with higher chance of FPE. Patients with lower NIHSS scores at admission and FPE have a better clinical prognosis at 90 days after surgery.

To explore the functional recovery of patients with severe aneurysmal subarachnoid hemorrhage (SaSAH) and influencing factors for neurological improvement following SaSAH.

A retrospective analysis was performed on the clinical data of patients who received neurosurgical intensive care unit treatment post operation in the Department of Neurosurgery of the Second Affiliated Hospital of Soochow University from January 2016 to December 2020. Modified Rankin Scale (mRS) scores were assessed at discharge and 6 months after discharge and the results were compared. Good functional status was defined as a mRS score of 0-3. Neurological improvement was defined as a reduction in the mRS score by at least one grade. Univariate contingency statistics and multivariate logistic analysis were performed to determine the influencing factors for neurological improvement following SaSAH. Then, independent risk factors were used as variables to construct a joint prediction model. The receiver operator characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive value of independent risk factors and joint prediction model.

A total of 154 patients were enrolled into this study. Six months after discharge, 53.2% (82/154) of patients achieved good neurological recovery. Neurological improvement was reported in 51.9% (80/154) of the patients, and there was a statistical difference between the mRS score at discharge (3.75±0.97) and at 6 months post operation (3.13±1.57) (paired t=7.86, P<0.001). Multivariate logistic analysis revealed that age>65 years (OR=15.74, 95%CI: 5.46-45.39, P<0.001), high-grade aneurysms (OR=5.96, 95%CI: 1.93-18.39, P=0.002), preoperative cerebral hernia (OR=15.26, 95%CI: 2.72-85.46, P=0.002) and postoperative cerebral infarction (OR=2.90, 95%CI: 1.13-7.45, P=0.027) were independent risk factors for neurological improvement. ROC curve showed that joint prediction model (with independent risk factors as variables) had excellent discrimination with an AUC value of 0.86(95%CI: 0.80-0.92, P<0.001).

Age >65 years, high-grade aneurysm, preoperative cerebral hernia and postoperative cerebral infarction could be unfavorable factors of neurological improvement. The joint prediction model constructed with independent risk factors can be used to effectively predict the improvement of neurological function of SaSAH patients.

To explore the clinical efficacy of contralateral seventh cervical nerve root transposition in the treatment of residual spastic hemiparesis after hypertensive intracerebral hemorrhage surgery.

A retrospective analysis was conducted on the clinical data of 6 patients with spastic hemiparesis admitted to the Department of Neurosurgery, Zhoukou Central Hospital from January to June 2021. Among them, 5 cases were primary hypertensive intracerebral hemorrhage and 1 case was gestational hepertension. All cases had spastic hemiplegia after surgical removal of intracranial hematoma. After ineffective rehabilitation training, all patients underwent contralateral seventh cervical nerve root transposition. The modified Ashworth scale (MAS) was used to assess the muscle tone of the affected limb; the simplified Fugl-Meyer motor function scale (FMA) was used to assess upper limb motor function; the Berg balance scale (BBS) was used to evaluate patients′ postural balance; and the Boston Diagnostic Aphasia Examination (BDAE) scale was used to grade patients′ language function.

The surgery was successfully completed in all 6 patients. There was no change in muscle strength of the contralateral limb after surgery, while numbness of the contralateral limb occurred in all patients and disappeared within 6 months after surgery. Weakness of the contralateral limb occurred in 5 cases and disappeared within 3 months after surgery, and neck swelling occurred in 4 cases and disappeared within 1 week after surgery. There were no other complications such as incision infection, respiratory difficulty, or sensation of swallowing foreign bodies. The differences in MAS grade, FMA score, and BBS score between preoperative, postoperative 6 months, and postoperative 12 months were statistically significant in all 6 patients (all P<0.05). Compared with preoperative values, muscle tone and upper limb motor function improved at 6 and 12 months postoperatively, and postural balance function improved at 12 months postoperatively, with statistically significant differences (all P<0.05). There were no statistically significant differences in BDAE grades of language function between preoperative, postoperative 6 months, and postoperative 12 months (F=3.71, P=0.156).

Contralateral seventh cervical nerve root transposition can improve muscle tone of the affected limb, enhance upper limb motor function, and improve postural balance in patients with spastic hemiparesis. It is an effective treatment method.

To explore the risk factors and their predictive roles in postoperative recurrence of chronic subdural hemorrhage (CSDH).

A retrospective study was conducted on the clinical data of 129 patients with CSDH who underwent routine drilling drainage surgery at the Department of Neurosurgery, First Affiliated Hospital of Shihezi University from January 2018 to May 2022. During the follow-up period of 3 months, patients were divided into recurrent and non-recurrent groups based on the recurrence of hematoma. Comparison of general patient data, medication history and preoperative laboratory examination indicators related to the function of blood clotting, pre-operative clinical symptoms, imaging data related to pre-surgical hematoma, multivariate logistic regression analysis was performed for indicators with statistically significant differences. Receiver operating characteristic curves (ROC) was drawn to evaluate the predictive effect of associated risk factors on recurrence after drilling drainage for CSDH.

Among 129 patients, a total of 24 (18.6%) hematomas recurred at 7-90 d after surgery. Univariate analysis showed that compared with the non-recurrence group (104 cases), the recurrence group (24 cases) had higher proportions of female and patients with history of smoking, dizziness at the onset, bilateral hematomas and segregation in the hematoma lumen and lower proportions of patients with history of trauma. In addition, recurrence group had shortened preoperative examination of some prothrombinogen time, prolonged prothrombin time, and high content of fibrin degradation products, little postoperative drainage of the hematoma, and high intracranial volume of pneumoperitoneum with significant differences in the above indexes (all P<0.05). Multivariate logistic regression analysis showed that gender (OR=24.19, 95%CI: 1.98-295.01), history of trauma (OR=0.08, 95%CI: 0.01-0.65), history of smoking (OR=70.19, 95%CI: 6.00-820.78), preoperative fibrin degradation products (OR=1.10, 95%CI: 1.03-1.17), partial thromboplastin time (OR=0.43, 95%CI: 0.22-0.86), prothrombin time (OR=5.13, 95%CI: 2.05-12.85), and postoperative intracranial air volume (OR=1.04, 95%CI: 1.01-1.07) were independent influencing factor for recurrence after CSDH drilling and drainage surgery (all P<0.05). The area under the curve of the ROC curve plotted from the above metrics was 0.96 (95%CI: 0.93-0.99) with an optimal cutoff value of 0.11. The sensitivity for predicting recurrence after CSDH drilling and drainage was 91.71% with the specificity of 88.60%.

Sex, history of trauma, history of smoking, fibrin degradation products, partial thromboplastin time, prothrombin time and postoperative intracranial air volume are predictors of recurrence after CSDH drilling with high predictive value.

To investigate the interaction between hypoxia-inducible factor-1α (HIF-1α) and syndecan-1 (SDC1) in the proliferation and chemoresistance of glioma cells under hypoxia.

U87 cells were divided into normoxia group, normoxia with temozolomide (TMZ) group, normoxia vector control group, normoxia vector control with DMSO group, normoxia vector control with TMZ group, normoxia SDC1 overexpression group, normoxia SDC1 overexpression with TMZ group, hypoxia group, hypoxia with TMZ group, hypoxia vector control group, hypoxia HIF-1α knockout group, hypoxia HIF-1α knockout with TMZ group, hypoxia SDC1 interference group, hypoxia vector control with DMSO group, hypoxia vector control with TMZ group and hypoxia SDC1 interference with TMZ group. Hypoxia probe was used to detect cell hypoxia. After TMZ treatment for 72 h, cell proliferation was detected by CCK-8, and cell apoptosis was detected by flow cytometry. After HIF-1α was knocked out, the cells were cultured under hypoxia conditions and treated with TMZ for 2, 4, 6, and 8 days, and the release of lactate dehydrogenase (LDH) and cell apoptosis were detected. The mRNA and protein expressions of HIF-1α and SDC1 were detected by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) and Western blot (WB). Chromatin immunoprecipitation (ChIP)-qPCR (ChIP-qPCR) was used to detect the binding between HIF-1α and SDC1 promoter. The tumor samples of Chinese Glioma Genome Atlas (CGGA) database (321 cases) and Gene Expression Profile Data Interactive Analysis (GEPIA) database (681 cases) were analyzed to reveal the expression of HIF-1α and SDC1 genes in different grades of glioma, the difference in survival time of glioma patients with high and low expression of SDC1, and the correlation between HIF-1α and SDC1 gene expression in gliomas.

CCK-8 and flow cytometry showed that compared with the normoxia with TMZ group, the cell survival rate was higher and the apoptosis rate was lower in the hypoxia with TMZ group (both P<0.01). WB showed that the expression of HIF-1α of cells in the hypoxia group was higher than that in the normoxia group (P=0.040). The expression of HIF-1α in hypoxia HIF-1α knockout group was lower than that in hypoxia vector control group. The LDH release and apoptosis rate in the hypoxia knockout HIF-1α with TMZ group were higher than those in the hypoxia vector control with TMZ group (both P<0.01). Compared with the hypoxia vector control group, RT-qPCR showed that SDC1 mRNA in the hypoxia HIF-1α knockout group was decreased(P<0.01). WB showed that the expression of SDC1 protein was decreased in the hypoxia HIF-1α knockout group (P<0.01). CCK-8 assay showed that the number of cells in the normoxic vector control with TMZ group was lower than that in the normoxic vector control with DMSO group (P<0.01) and normoxic SDC1 with TMZ group (P<0.01). The number of cells in hypoxia interference SDC1 with TMZ group and hypoxia vector control with TMZ group was lower than that in hypoxia vector control with DMSO group (P<0.01), while the number of cells in hypoxia interference SDC1 with TMZ group was lower than that in hypoxia vector control with TMZ group (P<0.01). Flow cytometry showed that the apoptosis rate of cells in normoxic over-expression SDC1 with TMZ group was significantly lower than that in normoxic vector control with TMZ group (P=0.030), while the apoptosis rate of cells in hypoxic interference SDC1 with TMZ group was significantly higher than that in hypoxic vector control with TMZ group (P<0.01). ChIP-qPCR analysis showed that HIF-1α binding sites were located between -1314 and -1310 on the SDC1 promoter. The results of GEPIA and CGGA databases showed that the expression levels of HIF-1α and SDC1 in glioma tissues were higher than those in normal brain tissues, and the expression levels increased accordingly with the increase of WHO grade of glioma (P<0.05). HIF-1α mRNA expression was positively correlated with SDC1 mRNA expression in glioma (P<0.05). The survival time of patients with low SDC1 expression was longer than that of patients with high SDC1 expression (P<0.01).

HIF-1α, as a transcription factor, promotes the proliferation and chemoresistance of glioma cells through SDC1 under hypoxia.

To systematically evaluate the efficacy and safety of hard-channel and soft-channel minimally invasive surgery for hypertensive intracerebral hemorrhage.

The relevant literatures on the efficacy and safety of hard-channel and soft-channel minimally invasive surgery for the treatment of hypertensive intracerebral hemorrhage in PubMed, Embase, The Cochrane Library, Web of Science, Wanfang Medical Network, CNKI, CBM and VIP databases were retrieved. The publication time of the literatures was up to December 31, 2022. The extracted outcome indicators included overall efficiency, NIHSS score, complete clearance rate of hematoma, postoperative hematoma volume, infection index C-reactive protein (CRP), serum oxidative stress factor superoxide dismutase (SOD) and postoperative complications. Cochran Q test was used to analyze literature heterogeneity. If the heterogeneity was high, random effect model was used to analyze. Otherwise, fixed effect model was used to pool effect size.

A total of 25 articles were included, including 19 randomized controlled trial and 6 retrospective clinical controlled studies. There were a total of 2 007 patients, including 1 002 cases of hard-channel minimally invasive procedure and 1 005 cases of soft-channel minimally invasive procedure. Meta analysis results showed that compared with patients undergoing hard-channel minimally invasive procedure, patients undergoing soft-channel minimally invasive procedure had lower postoperative NIHSS scores (MD=4.05, 95%CI: 2.91-5.18, P<0.001), lower complete hematoma clearance rate (OR=1.83, 95%CI: 1.08-3.11, P=0.020), lower postoperative CRP (MD=15.88, 95%CI: 12.33-19.53, P<0.001), higher serum SOD index (MD=-4.21, 95%CI: -5.23 - -3.19, P<0.001) and lower overall postoperative complication rate (OR=2.00, 95%CI: 1.08-3.69, P=0.030). However, there was no statistically significant difference in postoperative total effective rate or hematoma volume between the two surgical methods (both P>0.05).

The total effective rate of soft-channel and hard-channel minimally invasive procedure seems similar, and the total complication rate of soft-channel minimally invasive procedure may be lower.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease found in adults and children, and NF1 combined with high-grade glioma is relatively rare. This article reports the clinical data of a child with NF1 complicated with high-grade glioma of the brainstem. This child had neurological deficit symptoms after trauma; Whole exome gene sequencing confirmed that NF1 c.499_502het_deltGTT, p.C167Qfs variants were present at the same time as the mother, and there were frameshift variants and heterozygosity caused by TGTT deletion at the base of c.499-502 position. Diffuse midline glioma of the cervical medulla with H3K27M mutation was diagnosed by biopsy, with WHO tumor grade 4. No radiotherapy or chemotherapy was performed, and there was no tumor progression after 9 months follow-up.

Giant intracranial aneurysms have a low incidence but a high risk of rupture, which can lead to extensive subarachnoid hemorrhage and even life-threatening. In May 2020, the Department of Neurosurgery of Sun Yat-sen Memorial Hospital of Sun Yat-sen University treated a patient with giant intracranial aneurysm with blood flow guidance device. The aneurysm ruptured after operation, causing subarachnoid hemorrhage, and died after ineffective rescue.

Infectious subdural hematoma is a rare intracranial infectious disease, that is, subdural hematoma infection complicated by subdural abscess. This article retrospectively reports a newborn with infectious subdural hematoma treated by neuroendoscopy in the Department of Pediatric Neurosurgery of Wuhan Brain Hospital, Yangtze River Shipping General Hospital in October 2021. After the operation, anti-infective treatment was given, and the child recovered well.

Chordoma is a rare malignant tumor of residual chordal tissue origin. Due to the lack of effective treatment at present, chordoma is prone to local recurrence and distant metastasis, and most patients have poor prognosis. Recent studies on chordoma-related genomics have found that the chordoma genome is characterized by common chromosome aberrations and gene copy number variations, while the gene mutation load is relatively low. Moreover, several molecules and signaling pathways (such as Brachyury gene, chromatin remodeling related gene, PI3K/AKT/mTOR signaling pathway, CDKN2A gene, etc.) have been found to play an important role in the occurrence and development of chordoma, which provides guidance for the diagnosis and prognosis of chordoma, and is expected to become the molecular target of chordoma treatment.

Glioma is the most common primary malignant tumor in the cranium, and the recurrence rate ranks first among intracranial tumors. In recent years, with the in-depth research on nanomaterials, more and more nanomaterial drug loading systems have been established. In this paper, many ways of nanomaterials entering the central nervous system, the ways of nanomaterials targeting glioma recognition, and nanomaterials commonly used to target glioma are reviewed.

The optical pump atomic magnetometer magnetoencephalogram system based on the optical-radio frequency double resonance phenomenon has been gradually emerging in recent years. Because atomic magnetometer can work at room temperature, without liquid helium cooling, and is small in size and light in weight, optical pump atomic magnetometer magnetoencephalogram system has been recognized as the development direction of the next generation magnetoencephalogram. This paper expounds the current development of atomic magnetometer technology and its research status in magnetoencephalography, analyzes its technical advantages, and makes a prospect for the application of this new technology.

Acoustic neuroma is a benign tumor originating from Schwann cells in the vestibular nerve sheath. With the rapid development of medical technology and equipment, the main treatment methods of acoustic neuroma include conservative regular follow-up, stereotactic radiotherapy, surgical treatment and drug treatment. At present, the preferred treatment option is still surgical treatment. The goal of surgical treatment of acoustic neuroma has developed from early life saving, reducing the disability rate and total tumor resection to cranial nerve function protection and postoperative nerve function recovery. At present, there are more and more explorations on the preservation of cochlear nerve function and hearing reconstruction methods in neurosurgery. Hearing protection has gradually become the goal of contemporary acoustic neuroma treatment. However, there is no guideline or consensus to propose the best strategy for hearing protection. This article reviews the research progress of hearing protection strategies and hearing reconstruction techniques in acoustic neuroma, in order to improve the quality of life of patients.