Volume 39 · Issue 11 · 2023

After more than 20 years of development, endoscopic neurosurgery in China has gradually matured, and the quantity and quality of neuroendoscopic surgery in some neurosurgery centers have reached the advanced level in the world. High-quality development of endoscopic neurosurgery is the guarantee of sustainable progress of neuroendoscopic technology. It is necessary to adhere to the concept of continuously reducing surgical trauma, preserve and protect the normal anatomical structure to the maximum extent, and effectively improve the quality of surgery; It is necessary to improve the quality of life of patients as the core goal of surgery, and protect the normal physiological function of patients to the maximum extent while removing the lesions; It is necessary to attach importance to theoretical and technological innovation in the field of endoscopic neurosurgery, promote innovation on the basis of the accumulation of operation volume, and then promote the improvement of operation quality, so as to ensure the sustainable and high-quality development of endoscopic neurosurgery in China.

Chordoma is a rare subtype of sarcoma, which mainly occurs in the midline, including skull base, spine and sacrococcygeal region, of which skull base chordoma accounts for about 1/3^[1,2]。 The annual incidence of chordoma in Europe and the United States is approximately 0.08/100,000^[2]。 The median age at the time of skull base chordoma diagnosis is about 40 years^[3,4]。 Childhood chordomas are rare, with rates of 0.8/10 million in Europe and 1.4/10 million in the United States, respectively^[2]。 There were slightly more males than females, with a male: female ratio of approximately 1.5: 1.0^[2,5]。

To explore the clinical efficacy of neuroendoscopic transnasal surgery for the treatment of prolactinomas.

A retrospective study was conducted on the clinical data of 202 cases of prolactinomas who underwent neuroendoscopic surgery in the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from February 2008 to January 2018. Among them, there were 6 cases of micro-tumors, 152 cases of macro-tumors, and 44 cases of giant tumors; 62 cases were resistant to preoperative dopamine receptor agonists (DA); 17 cases were unable to tolerate adverse drug reactions. After surgery, the extent of tumor resection was evaluated based on brain MRI, and the endocrine outcome and the effect of tumor reduction on drugs were evaluated based on the serum prolactin levels. The clinical symptoms, physical examination, brain MRI, and endocrine laboratory examinations of the patients were monitored at 3, 6 and 12 months post surgery, as well as annually thereafter. This allowed for a comparison of the clinical treatment outcomes between large and giant tumors.

Neuroendoscopic surgeries were successfully performed on all 202 patients. Complete tumor resection was achieved in 128 cases (63.3%), while subtotal resection, major resection, and partial resection were observed in 45 cases (22.3%), 21 cases (10.4%), and 8 cases (4.0%), respectively. Postoperative complications included cerebrospinal fluid rhinorrhea in 1 case (0.5%), vision loss in 2 cases (1.0%), internal carotid artery injury in 1 case (0.5%), and transient diabetes insipidus in 38 cases (18.8%). A total of 192 patients underwent clinical follow-up, with a median (Q₁, Q₃) period of 70.5 (55.0, 86.0) months. The final follow-up revealed that 113 patients (58.9%) had normal prolactin level, while 12 patients(6.3%) experienced tumor recurrence and 1 patient(0.5%) succumbed to the disease. Of the 62 patients with preoperative drug resistance, 28 (45.2%) achieved biochemical remission and 9 (14.5%) became drug sensitive. Among the 17 patients who could not tolerate adverse drug reactions before operation, 13 patients achieved biochemical remission and 3 patients turned to drug tolerance. Compared with giant tumors, macro-tumors had a higher proportion of total tumor resection and a lower proportion of postoperative complications (both P<0.05), while the improvement rate of postoperative clinical symptoms, endocrine cure rate at the last follow-up and tumor recurrence rate were not significantly different (all P>0.05).

Neuroendoscopic transnasal surgery can lead to biochemical cure or relief for most patients with prolactinomas, and can also convert some patients from DA resistance to sensitivity or from intolerance to tolerance, making it a preferred initial treatment option for prolactinomas.

To investigate the efficacy and safety of endoscopic transnasal transsphenoidal approach for the treatment of different types of pituitary neuroendocrine tumor(PitNET) extending to the suprasellar region.

A retrospective analysis was conducted on the clinical data of 59 patients with PitNET (maximun diameter≥3 cm) extending to the suprasellar region who were admitted to the Neurosurgery Department of the First Affiliated Hospital of Fujian Medical University from January 2018 to December 2020. According to the growth of tumors, 59 patients were classified into types Ⅰ-Ⅳ. There were 20 cases of type Ⅰ, 3 cases of type Ⅱ, 12 cases of type Ⅲ and 24 cases of type Ⅳ. All patients underwent surgery via endoscopic transnasal transsphenoidal approach for tumor resection. Clinical follow-up and imaging follow-up were performed at 3 months post surgery to evaluate the degree of tumor resection, biochemical response rate, and incidence of complications.

All patients were followed up. At 3 months post surgery, 66.1% (39/59) of the patients achieved gross total resection, including 100% (20/20) of type Ⅰ tumors, 2/3 of type Ⅱ tumors, 9/12 of type Ⅲ tumors, and 33.3% (8/24) of type Ⅳ tumors. All patients with functional PitNET (including 4 cases of acromegaly and 1 case of Cushing′s disease) achieved biochemical remission. Postoperative complication included 41 cases of transient diabetes insipidus, 11 cases of hyponatremia, 24 cases of transient hypopituitarism, 9 cases of intracranial infection, 2 cases of cerebrospinal fluid leakage and 1 case of blindness, all of which were cured after treatment except the case of blindness.

Endonasal endoscopic approach for the treatment of PitNET extending to the suprasellar region has mild complications and overall satisfactory outcomes. It is particularly suitable for those types of tumors that only extend to the suprasellar region, to the suprasellar region and anterior skull base, or to the suprasellar region and posterior cranial fossa.

To explore the feasibility and efficacy of optic nerve extended decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy (TON).

A retrospective analysis was performed on the clinical data of 43 patients of TON who were consecutively admitted and treated at the Department of Neurosurgery, the Affiliated Li Hui Li Hospital of Ningbo University from March 2018 to October 2022. The optic nerves of 24 patients(control group) were decompressed through neuroendoscopic transethmoidal-sphenoidal approach, whereas optic nerves of 19 patients (experimental group) were dealt with extended decompression through optic strut grinding. The duration of operation, intraoperative blood loss and hospitalization and so on were compared between the two groups. The efficacy of treatment was evaluated based on the visual change. Safety of treatment was determined based on the occurrence of postoperative complications.

The duration of operation in control group ranged from 56.3 min to 103.5 min (mean: 76.6±23.4 min), which was significantly different from that in experimental group (range: 75.1-121.6 min, mean: 93.2±17.9 min) (t=2.55, P=0.009). The intraoperative blood loss and hospitalization exhibited no statistical difference between the two groups (both P>0.05). Of 24 cases in the control group, there was no light perception in 6 cases, light perception in 10, hand motion in 6 and counting fingers in 2 before operation. At 3 months post operation, the results showed no light perception in 5, light perception in 7, hand motion in 7, counting fingers in 3 and Log MAR≥0.02 in 2. Of 19 cases in the experimental group, there was no light perception in 4 cases, light perception in 7, hand motion in 6 and counting fingers in 2 before operation. At 3 months post operation, the results showed no light perception in 3, light perception in 4, hand motion in 3, counting fingers in 6 and Log MAR≥0.02 in 3. The visual acuity of 9 patients in control group improved and that of 13 patients in experimental group improved. The proportion of efficacy of optic nerve extended decompression in the treatment of TON was significantly different from that of decompression through neuroendoscopic transethmoidal-sphenoidal approach (χ²=4.06, P=0.036). No surgical complications such as cerebrospinal fluid rhinorrhea, internal carotid artery injury or anosmia occurred in either group.

Optic nerve extended decompression by optic strut grinding with neuroendoscopic transethmoidal-sphenoidal approach seems to be more effective for the treatment of TON compared with the ordinary optic nerve decompression, and this operative method is also safe.

To evaluate the effectiveness and safety of keyhole endoscopic surgery for acute traumatic subdural hematoma.

The clinical data of 40 patients with acute traumatic subdural hematoma who were treated by neurosurgery in the Department of Neurosurgery, Fujian Provincial Hospital South Branch from January 2016 to January 2022 were retrospectively analyzed. Among them, 20 cases underwent neuroendoscopic keyhole hematoma removal (minimally invasive group) and 20 cases underwent conventional large bone flap craniotomy (conventional group). There was no statistically significant difference in baseline data such as gender, age, and preoperative subdural hematoma volume between the two groups of patients (all P>0.05), indicating comparability. We then analyzed and compared the surgical conditions (including operative duration and intraoperative bleeding volume), postoperative Glasgow Coma Scale (GCS) at 1 day, postoperative complications, and Glasgow Outcome Scale (GOS) at 6 months between the two groups of patients.

Both groups of patients successfully underwent the surgery, and there was no case of extended surgery in the minimally invasive group. Compared with the conventional group, the minimally invasive group had shorter surgical duration (73.8±6.7 min vs. 138.3±16.8 min, t=15.92), less intraoperative bleeding (26.7±4.7 ml vs. 96.5±13.1 ml, t=22.46), less residual hematoma after surgery (3.5±1.3 ml vs. 7.6±2.6 ml, t=6.24) and shorter hospital stay (10.3±2.9 d vs. 13.8±3.2 d, t=3.71). The differences were statistically significant (all P<0.05). Compared with the preoperative group, the postoperative GCS of the minimally invasive group and the conventional group increased 1 day, and the difference was statistically significant (paired t-value: 15.70 and 13.65 respectively, both P<0.001). There was no statistically significant difference between the two groups in the postoperative GCS at day 1, the incidence of epilepsy, pulmonary infection or intracranial infection (all P>0.05). At 6 months after surgery, all patients had the GOS of grade Ⅴ and there was no statistically significant difference between the two groups (P=1.000).

Compared with conventional large bone flap craniotomy, neuroendoscopic keyhole surgery for acute traumatic subdural hematoma could help shorten the surgical and hospitalization time, reduce intraoperative bleeding and residual hematoma, and is associated with comparable incidence of complications and prognosis. It is a safe, effective, and minimally invasive method.

To investigate the influencing factors and stratified skull base reconstruction strategies for cerebrospinal fluid leakage during endoscopic transnasal transsphenoidal resection of pituitary neuroendocrine tumor (PitNET).

A retrospective analysis was conducted on the clinical data of 237 patients with PitNET who were admitted to the Neurosurgery Department of People′s Hospital of Xinjiang Uygur Autonomous Region from June 2020 to December 2022. All patients underwent endoscopic transnasal transsphenoidal tumor resection. According to whether cerebrospinal fluid leakage occurred during operation, the patients were divided into two groups: non-leakage group (198 cases) and leakage group (39 cases). In addition, according to the Kelly criteria for cerebrospinal fluid leakage (grade 0 for all patients in non-leakage group and grades 1-3 for those in leakage group), a stratified skull base reconstruction strategy was adopted. The clinical data of the two groups were analyzed and the influencing factors of cerebrospinal fluid leakage during operation were analyzed by multivariate logistic regression.

Among 237 patients, 198 had no cerebrospinal fluid leakage during operation and 39 had cerebrospinal fluid leakage during operation. Among them, Kelly grade 0 was reported in 198 cases, grade 1 in 27, grade 2 in 9, and grade 3 in 3. All patients successfully underwent skull base reconstruction. Intracranial infection occurred in 2 patients after operation, and no new cerebrospinal fluid leakage complication occurred. All 237 patients received clinical follow-up, with a median follow-up time of 7.5 months (3-12 months). As of the last follow-up, no complications such as cerebrospinal fluid leakage or intracranial infection were observed. There were significant differences in the maximum tumor diameter, tumor location, tumor texture, times of operation and tumor resection degree between the cerebrospinal fluid leakage group and non-leakage group (all P < 0.05). Multivariate logistic regression analysis showed that maximum tumor diameter(OR=1.24, 95%CI: 1.13-1.36), tumor location(OR=0.17, 95%CI: 0.04-0.80), tumor texture(OR=15.38, 95%CI: 4.61-51.28) and operation times(OR=14.76, 95%CI: 2.44-89.19) were independent influencing factors for cerebrospinal fluid leakage during endoscopic transnasal sphenoidal resection of pituitary adenomas(all P < 0.05).

Patients with PitNET with large maximum diameters and tough textures, and patients undergoing secondary surgery have a higher risk of cerebrospinal fluid leakage during neuroendoscopic transnasal sphenoidal tumor resection.The pituitary adenomas located on the sella is a protective factor for cerebrospinal fluid leakage during the operation. Stratified skull base reconstruction strategy, adopted based on the cerebrospinal fluid leakage grading standards, seems safe and effective.

To assess the therapeutic efficacy of flexible endoscopic aqueductal stent (AST) combined with long tunneled external ventricular drainage (LTEVD) for the treatment of isolated fourth ventricle (IFV) with infectious status.

We retrospectively analyzed the clinical data of 6 IFV patients with infectious status who underwent AST combined with LTEVD at the Neurosurgery Department of the Aviation General Hospital from January 2015 to January 2023. Preoperative Glasgow coma scale (GCS) scores were as follows: 3 points in 2 cases, 4 points in 1 case, 6 points in 1 case, 7 points in 1 case, and 15 points in 1 case. Postoperatively, all patients received anti-infection treatment according to cerebrospinal fluid pathogens results. The change rate of fourth ventricular volume was proposed to assess the fourth ventricular volume change post operation, with a rate of <33% indicating mild improvement, 33%-67% indicating moderate improvement, and >67% indicating significant improvement.

A total of 6 patients underwent the operation of flexible AST combined with LTEVD. Among them, 4 patients had multiple ventricular adhesions, with 2 undergoing fenestration of the septum pellucidum and 2 undergoing ventricular fenestration. Two patients with trapped temporal horns underwent long tunneled temporal horn external ventricular drainage. One patient underwent LTEVD revision. The mean drainage duration was 73 d (29-207 d), with no complications or new infection events observed. Three patients subsequently underwent the fourth ventriculoperitoneal shunt. The mean follow-up period for the 6 patients was 10.3 months (3.0-25.0 months). At the last follow-up, GCS scores were 7 in 2 cases and 6, 9, 12, and 15 in 1 case each. The average rate of change in the fourth ventricular volume for 5 patients was 83.4% (67.3-97.9%), with one case showing moderate reduction to 55.2%.

The use of flexible AST combined with LTEVD is a safe and effective treatment strategy for IFV in severe infectious status.

The clinical data of 3 patients who underwent neuroendoscopic transnasal resection of granular pituitary cell tumors at the Neurosurgery Center of Beijing Tiantan Hospital affiliated to Capital Medical University from January 2019 to January 2022 were retrospectively analyzed, and the diagnostic methods of granular pituitary cell tumors and the experience of neuroendoscopic transnasal resection were summarized. Among them, the tumor reached total resection in 2 cases and subtotal resection in 1 case. Three patients were followed up for 1.6 to 4.5 years, and all of them could live normally until the last follow-up. Tumor recurrence occurred in one patient and no recurrence occurred in the remaining 2. Neuroendoscopic transnasal surgical resection of granular pituitary cell tumor is safe and effective.

To evaluate the safety and efficacy of domestic Numen coil in the treatment of intracranial unruptured aneurysms.

A prospective, multicenter, open, randomized controlled, non-inferiority clinical trial-CATCH trial was completed jointly by 10 clinical trial centers, including the First Affiliated Hospital of Naval Medical University, from April 2017 to February 2019, in which a subgroup of 240 cases of unruptured intracranial aneurysms was included for analysis. The patients were classified into the Numen group and Axium group. The primary outcome was the rate of successful occlusion of the aneurysm (Raymond grade Ⅰ or Ⅱ) at 6 months postoperatively. The secondary outcomes included the rate of complete occlusion of the aneurysm (Raymond grade Ⅰ) at 6 and 12 months postoperatively and the rate of recanalization of aneurysm at 6 months postoperatively. The safety indicators were aneurysm retreatment rate at 6 and 12 months postoperatively and the rate of serious adverse events.

In the full analysis set, the Numen group (123 patients) had a lower percentage of patients with essential hypertension compared with the Axium group (117 patients) (P=0.030), whereas the differences in baseline data such as gender and age were not statistically significant (all P>0.05). In the per-protocal set, the rates of successful aneurysm occlusion [93.2% (96/103) vs. 95.9% (94/98)], complete occlusion [65.0% (67/103) vs. 63.3% (62/98)], and recanalization [5.9% (6/101) vs. 2.1% (2/97)] at 6 months postoperatively were not statistically significant between the two groups (all P>0.05). The difference in the rate of complete occlusion of the aneurysm at 12 months postoperatively was not statistically significant [both of them were 74.4% (67/90), χ²=0.00, P=1.000]. There was no statistically significant difference in the immediate postoperative packing density [(41.90±22.32)% vs. (45.72±19.51)%, t=-1.30, P=0.198]. In the full analysis set, none of the differences in effectiveness indicators between the two groups was significant (P > 0.05). In the safety analysis set (123 patients in the Numen group and 117 patients in the Axium group), at 12 months postoperatively, 1 patient in the Axium group was retreated (1/112, 0.9%), none of the 116 patients in the Numen group was retreated, and the difference between the two groups was not statistically significant (P=0.491). At 12 months post operation, there was no statistically significant difference in the incidence of serious adverse events between the Numen group and Axium group [13.0%(16/123) vs. 17.9%(21/117), χ²=1.18, P=0.289]. The mortality rate of patients was 0 in both groups.

Numen coils demonstrate similar safety and efficacy as Axium coils for the treatment of unruptured intracranial aneurysms and could be used as a safe and effective method.

To explore the clinical characteristics, treatment strategies and prognosis of choroid plexus carcinomas (CPC) in infants and young children.

We retrospectively analyzed the clinical data of 6 children with CPC who were admitted to the Neurosurgery Department of Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University from January 2015 to December 2020. The tumors were all located in the lateral ventricle, and the tumor resection was performed through the temporal occipital junction area and the lateral ventricular triangle zone. Regular clinical follow-up visits were conducted at 1, 3, and 6 months after the operation, 1 year after the operation, and every year thereafter to see whether the children received radiotherapy and chemotherapy after the operation, whether they underwent secondary surgery, whether there was tumor dissemination and metastasis, and the survival status and outcomes.

The median age of the 6 children at diagnosis was 29.5 months (5-38 months). Except for 1 child who was asymptomatic at the time of treatment, the remaining 5 children were accompanied by symptoms of increased intracranial pressure such as nausea and vomiting. Preoperative brain MRI T1-weighted imaging showed that the tumor was iso- or hypointense, T2-weighted imaging showed slightly high signal, and enhancement sequences showed varying degrees of enhancement. The first operations of all 6 children were successfully completed, with total tumor resection in 4 cases and partial resection in 2 cases. No surgery-related complications occurred after operation. Postoperative pathological staining showed obvious nuclear divisions and a Ki-67 positive index of 30% to 65%. All cases were confirmed to be CPC. The median follow-up time of 6 children was 36 months (6-59 months); 4 children(2 cases had tumor recurrence) underwent secondary surgery, 2 cases had total tumor resection and 2 cases had partial resection. As of the last follow-up, 4 patients were alive and 2 had died. The 4 surviving children all received adjuvant carboplatin + vincristine chemotherapy after surgery, and 2 patients received adjuvant whole-brain and spinal cord radiotherapy at the same time. Their clinical symptoms improved, their growth and development were normal, and their outcomes were good. The two children who died did not receive adjuvant treatment such as radiotherapy or chemotherapy after surgery. They died after multiple intraventricular dissemination and metastases.

CPC mostly occurs in infants and young children, and is often accompanied by increased intracranial pressure. The tumor should be surgically removed as completely as possible. If recurrence occurs after surgery, a second surgical resection should be considered. For children with residual or metastatic tumors after surgery, adjuvant therapy such as radiotherapy and chemotherapy can be considered, which can improve prognosis.

Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy (CEA) is a classic neurosurgical procedure for severe carotid artery stenosis. However, CEA is generally performed under general anesthesia in China. This study retrospectively reports the clinical data of 6 patients with severe carotid artery stenosis treated with CEA under local anesthesia in the Department of Neurosurgery, Tianjin Medical University General Hospital from April 2018 to July 2021. The median postoperative follow-up time of 6 patients was 24 months (3-48 months); Up to the last follow-up, none of the patients had stroke events. Carotid color Doppler ultrasound or CT angiography showed smooth blood flow in the carotid artery on the operative side and no restenosis occurred.

To explore the effect of neurotization of bilateral fourth lumbar spinal nerve roots on hindlimb paralysis after central neurologic diseases in rats and the principle of postoperative cerebral cortical remodeling.

A model of the right leg paralysis after central neurological diseases was created by infusion of autologous arterial blood. Animal models were evaluated using electromyography and behavioral testing. The experiment was divided into 5 groups: bilateral L₄ exposure group, transection group, and neurotization group of model rats, as well as bilateral L₄ transection group of healthy rats and healthy rat group, with 12 rats in each group. Neurobehavioral tests were performed on five groups of rats at 1, 9, 13, and 17 weeks after surgery. Neuroelectrophysiological tests and retrograde tracing were performed on the model rat bilateral L₄ neurotization group and the healthy rat group. Resting-state and task-state functional magnetic resonance (fMRI) scans were performed. Post-processing and visual reconstruction of the obtained data were conducted.

The modeling success rate of the rat central right lower limb paralysis model was 71.7% (43/60). After surgery, the right lower limb (affected side) of the model rats in the bilateral L₄ neurotization group had no obvious extension and flexion movements. At 17 weeks after surgery, the hip, knee, and ankle joints showed extension and flexion movements. The results of repeated measures analysis of variance showed that the differences in postoperative Basso-Beattie Bresnahan locomotor rating scale (BBB rating scale) scores and slippage rates in rod test among the five groups of rats were statistically significant (all P<0.05). One week after surgery, compared with the bilateral L₄ transection group of healthy rats and the healthy rat group, the rats in bilateral L₄ exposure group, transection group, and neurotization group of model rats had lower BBB scores of the affected limbs and higher rod test slippage rates (all P<0.05). Over time, the BBB score of the affected limb in the bilateral L₄ neurotization group increased and the rod test slippage rate decreased (both P<0.05), and the BBB score of the affected limb at 17 weeks after surgery was the same as that of healthy rats (P>0.05). In nerve conduction testing, as time went by, the compound muscle action potential latency of the rats in bilateral L₄ neurotization group gradually shortened and the amplitude gradually increased (both P<0.05). At 17 weeks after surgery, the rats in bilateral L₄ neurotization group had no significance difference in the amplitude or latency of compound muscle action potential from the healthy rats (both P>0.05). The retrograde tracing test showed that 9 weeks after surgery, a large number of fluorogold labeled cells were widely distributed at the distal end of the L₄-L₄ regenerated nerve root anastomosis in the model rats of bilateral L₄ neurotization group, and the fluorescence distribution was sparse at the proximal end of the anastomosis. In the L₄ segment spinal cord section, a large number of fluorogold-labeled motor neurons gathered in the left anterior horn of the spinal cord, and the number was not statistically different from that in the healthy rat group (25 695±433 vs. 27 745±387, t=1.69, P=0.078). The fMRI results showed that 2 months after bilateral L₄ neurotization, a small area of activation appeared next to the motor cortex on the contralateral side; 4 months after surgery, the new activation area on the contralateral side increased, and the supplementary motor area of the cerebral cortex on the affected side was activated; 8 months after surgery, the new activation area in the cortex on the affected side did not increase compared with before, while the activation area in the cortex on the unaffected side shrank significantly.

Bilateral L₄ nerve root neurotization can activate cerebral cortical remodeling to generate a representative area of the affected limb, and repair the flexion and extension movements of the affected lower limb in rats with central lower limb paralysis.

To investigate the relationship between expression level of Hsa_circRNA_0006168 and prognosis of patients with gliomas, the effect of Hsa_circRNA_0006168 on glioma cell proliferation, migration and invasion, and the influence on temozolomide (TMZ) sensitivity.

A total of 86 tissue samples from glioma patients and 25 normal brain tissue samples were collected, and the expression level of Hsa_circRNA_0006168 was detected by real-time quantitative PCR. Kaplan-Meier method was used to analyze the relationship between the expression of Hsa_circRNA_0006168 and the survival of patients with gliomas. Univariate and multivariate Cox regression analyses were used to analyze the factors affecting the prognosis of patients with gliomas. Glioma cells U251 were selected and randomly divided into siRNA-circ inhibition group, siRNA-NC group and NC group. CCK-8 method was used to detect the proliferation of cells and the sensitivity of temozolomide (TMZ). Transwell assay was used to detect cell migration and invasion abilities

Compared with normal brain tissue and normal human glioma cells, Hsa_circRNA_0006168 expression level in glioma tissues and glioma cells was significantly increased (P<0.001). The expression level of Hsa_circRNA_0006168 in the tissues of high-grade glioma patients was significantly higher than that of low-grade glioma patients (2.06±0.81 vs. 0.97±0.38, P<0.001). Kaplan-Meier analysis showed that high expression of Hsa_circRNA_0006168 was associated with shorter survival in glioma patients (P<0.001). Multivariate Cox regression analysis showed that in addition to high-grade glioma, distant tumor metastasis and TMZ resistance (all P<0.05), high expression of Hsa_circRNA_0006168 was also a risk factor affecting the survival of patients with gliomas (HR=3.32, 95%CI: 2.92-7.31, P<0.001). The expression level of Hsa_circRNA_0006168 in siRNA-circ inhibition group, siRNA-NC group and NC group was 0.28±0.13, 0.90±0.34 and 0.87±0.31 respectively, and the differences were statistically significant (P<0.001). The cell proliferation rate of siRNA-circ inhibition group was lower than that of siRNA-NC group (P<0.001). The results of 24 h transwell cell culture showed that the number of migrated U251 cells in the siRNA-circ inhibition group, siRNA-NC group and NC group were 81.35±10.72, 173.26±28.40 and 174.80±27.25 respectively. After 48 h of culture, the number of invaded U251 cells in the three groups were 39.85±6.24, 106.48±14.73 and 104.72±13.84 respectively with statistical significance (all P<0.001). When cultured cells were treated with different concentrations of TMZ for 24 h, the survival rate of U251 cells in siRNA-circ inhibition group was decreased compared with that in siRNA-NC group with statistical significance (P<0.001).

Hsa_circRNA_0006168 is highly expressed in glioma tissues and cells, which is related to the poor prognosis of glioma patients. Downregulation of Hsa_circRNA_0006168 expression can inhibit the proliferation, migration and invasion of glioma cells and promote the sensitivity to TMZ chemotherapy.

To investigate the work intensity, work stress, and career satisfaction of Chinese neurosurgeons and to provide data support for the formulation of relevant policies.

A stratified cluster random sampling method was used to select neurosurgeons to anonymously fill out the questionnaire online. We then analyzed their working hours, work intensity, work pressure, career satisfaction, and the correlation between career satisfaction and various indicators.

A total of 2 095 valid questionnaires were collected. Among the survey respondents, 2 050 (97.9%) were male; the age [M (Q₁, Q₃)] was 39 (34, 46) years old. The median weekly overall, clinical, and scientific research working hours of the survey subjects were 60, 50, and 4 hours respectively. The median number of surgeries per month was 10. The proportions of neurosurgeons with daily sleep time <6 hours, those who had not taken annual leave, and those who believed that their work intensity and pressure were high accounted for 25.7% (539/2 095), 58.5% (1 226/2 095), 81.1% (1 700/2 095) and 83.4% (1 747/2 095) respectively. Those who were satisfied with their careers accounted for 64.2% (1 345/2 095), and their career satisfaction was negatively correlated with the total hours of work per week, feelings of work intensity, and feelings of work pressure (r values: -0.13, -0.20, and -0.28 respectively, all P < 0.05) and positively correlated with the monthly number of surgical operations, daily sleep duration, and annual leave duration (r values: 0.09, 0.10, and 0.08 respectively, all P < 0.05).

Chinese neurosurgeons generally believe that the work intensity and pressure are high and their career satisfaction is not optimistic, suggesting that practical measures should be taken to solve the challenge faced by Chinese neurosurgeons.

Juvenile hyalinin fibromatosis (JHF) is a rare autosomal recessive disease. Etiology ANTXR2 mutation, characterized by abnormal growth of hyaline fibrous tissue; There is no effective radical cure. This paper reports a male child with JHF diagnosed by pathology. The child was born by consanguineous marriage. The main manifestations were occipital tumor, gingival hyperplasia, paranasal verrucous hyperplasia, joint contracture and osteolysis. Genome sequencing revealed homozygous mutations in the ANTXR2/CMG2 gene. The child underwent surgery to remove the head nodule.

Solid tumor meningeal metastasis (LM) is a rare late complication in patients with solid tumors with extremely poor prognosis and limited therapeutic options. With the control of extracranial tumors, the incidence of LM gradually increases. The main treatment methods for LM include surgery, radiotherapy, systemic chemotherapy, targeted therapy, immunotherapy and intrathecal injection therapy, but there is no standard treatment plan at present. In recent years, with the update and iteration of diagnosis and treatment technologies, and further research on combination treatment options, the diagnosis rate and quality of life improvement rate of LM patients have been continuously improved, and the survival time has been significantly prolonged. This article will review the research progress of diagnosis and treatment of LM.

Traumatic brain injury (TBI) is a serious threat to people's life and health, and post-TBI epilepsy (PTE) is one of its serious sequelae. Since the pathophysiological mechanism of PTE has not been elucidated, there is no effective prevention and treatment at present. TBI triggers a strong and long-lasting inflammatory cascade, suggesting that neuroinflammation may be involved in the pathogenesis of PTE. And microglia, as the most common immune cells in the brain, play an important role in neuroinflammation. Microglia are activated after TBI and can express such phenotypes as pro-inflammatory or anti-inflammatory. Different polarization states are related to the release of various pro-inflammatory or anti-inflammatory mediators, and affect the repair of brain and the occurrence and development of PTE to varying degrees. Given that different phenotypes of microglia play different roles in neuroinflammation, modulating the polarization direction of microglia may have important implications for the treatment of patients with TBI and PTE. In this paper, the phenotype and function of microglia at different time points after TBI were reviewed, the signaling pathways of microglia polarization and the underlying mechanisms leading to epilepsy were deeply explored, and the research progress of drugs for the prevention and treatment of TBI and PTE was summarized, in order to lay a foundation for the clinical translation of PTE animal experiments.

Meningioma is the most common primary intracranial tumor in adults. At present, the risk of tumor progression is mainly judged according to World Health Organization (WHO) classification. However, in clinical practice, it has been found that the course of disease in some patients is not consistent with WHO classification. Some patients with WHO grade 1 meningiomas can relapse in a short time, while some WHO grade 3 meningiomas hardly relapse. Recent studies have confirmed that the genetic changes, chromosome copy number variations and DNA methylation changes of meningiomas are related to their biological behavior and prognosis. On this basis, the research of integrated molecular pathological typing of meningioma combining gene changes, chromosome copy number variation and DNA methylation changes has been carried out one after another, and the results of these studies consistently show that compared with histological typing based on WHO grading only, integrated molecular pathological typing can better predict the risk of meningioma recurrence and has more guiding value for treatment. This article reviews the research progress of integrated molecular pathology classification of meningioma.

Acute ischemic stroke is characterized by high morbidity, disability, mortality and recurrence. In recent years, mechanical thrombectomy has become the most effective treatment for acute ischemic stroke. Although this method has achieved a high prognosis rate as a whole, the damage caused by the thrombectomy device itself to blood vessels cannot be ignored, resulting in poor treatment effect or certain complications. How to reduce or avoid the damage to blood vessels is an important factor to be considered when designing mechanical thrombectomy device. Therefore, this article reviews the research progress of vascular injury caused by stent thrombectomy and related device structural design, in order to minimize vascular injury and improve the safety and effectiveness of this operation.