Volume 39 · Issue 12 · 2023

Combined transpetrous approach plays an important role in the modern skull base approach system. When this approach is used to treat petroclinal lesions in the petroclinal region or partially involving the cavernous sinus region, a deep understanding of the structure of the skull base veins and the method of dural incision is crucial. The superficial middle cerebral vein is the "gate" of blood flow in the cerebral hemisphere, involving three major skull base drainage channels: cavernous sinus, pterygoid venous plexus and suprapetrous sinus. Among them, sphenoidal basal vein, sphenoidal petrous vein and superior petrous vein are closely related to the choice of transpetrous surgical approach and venous protection strategy. The technique of dural incision is constantly evolving to protect important venous structures as much as possible while increasing the exposure space. This article combs the context of the above-mentioned technical improvement, and discusses the management strategies of related venous structures and dura mater in combined transpetrous approach.

The application of endoscopic skull base surgery technique began with the resection of pituitary neuroendocrine tumors (PitNETs) by neuroendoscopic transnasal-sphenoidal approach. Neuroendoscopic transnasal surgery for PitNETs has less surgical trauma, clear tumor exposure, complete resection and low recurrence rate. In recent years, with the advancement of neuroendoscopic technology, the indications of neuroendoscopic transnasal resection of PitNETs are increasing, and many tumors that invade cavernous sinus, suprasellar and slope can also be resected by neuroendoscopic transnasal approach^[1,2,3,4]； At the same time, for functional PitNETs, neuroendoscopic transnasal approach can safely and thoroughly identify and treat adjacent structures such as pseudocapsule of tumor, normal pituitary gland and medial wall of cavernous sinus, and further improve the endocrine cure rate of tumor^[5,6,7]。

To explore the efficacy, survival outcome, and prognostic factors of endoscopic skull base ventral resection of skull base chordomas in children.

A retrospective analysis was conducted on the clinical data of 70 children with skull base chordomas who underwent endoscopic skull base ventral resection at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from December 2007 to December 2022. Among them, 33 cases from 2007 to 2019 were in the early surgery group and 37 cases in 2020-2022 were in the recent surgery group. Recently, the surgical team adopted a " turtle-back-shaped" surgical strategy of sequential exploration and tumor resection. We then investigated the extent of tumor resection and its influencing factors in children. The progression-free survival (PFS) and overall survival (OS) of the children were followed up. Kaplan-Meier survival analysis was performed to compare the differences in the survival among children with different disease characteristics. Indicators with statistically significant differences were incorporated into the multivariate Cox regression model to analyze the related factors affecting the patients′ survival.

A total of 80 operations were performed on 70 children. Among those who underwent early surgery, total tumor resection accounted for 23.7% (9/38) and among those who underwent recent surgery accounted for 54.8% (23/42). Among children with tumor volume <20 cm^3, 20-80 cm^3, and >80 cm^3, total tumor resection accounted for 63.3% (19/30), 26.8% (11/41), and 2/9 respectively. Among children with primary and recurrent tumors, total tumor resection accounted for 51.9% (27/52) and 17.9% (5/28) respectively. The differences in the above indicators were all statistically significant (all P<0.05). However, there was no statistically significant difference in the total tumor resection rate between patients with different tumor locations and surgical approaches (all P>0.05). Postoperative pathology confirmed that 63 cases of chordoma were conventional type, 5 cases were poorly differentiated type, and 1 case each was dedifferentiated type and sarcomatoid type (the latter three subtypes were defined as other subtypes). The median postoperative follow-up time was 31 months (2-173 months). During the follow-up period, 11 cases (15.7%) died and 59 cases (84.3%) survived. None of the children with total tumor resection died. Kaplan-Meier survival analysis showed that the 1-, 2-, and 5-year survival rates of children with traditional chordomas were 95.0%, 95.0%, and 89.8% respectively, while the 1- and 2-year survival rates of other subtypes were 57.1% and 21.4 % respectively. Larger tumor volume and smaller degree of resection were associated with shorter OS of children (both P<0.05). Gender, primary or recurrent tumors, tumor location, or whether radiotherapy was administered had little impact on OS (all P>0.05). The children with smaller degree of tumor resection and those who did not receive radiotherapy before tumor recurrence had shorter PFS (both P<0.05); while gender, primary or recurrent tumor, tumor location or volume had little effect on PFS (all P>0.05). The OS and PFS of patients with Ki-67>6% were shorter than those with Ki-67≤6% (both P<0.05). Multivariate Cox regression analysis showed that the extent of tumor resection was an important influencing factor for OS (HR=3.44, 95%CI: 1.02-11.64, P=0.047) and PFS (HR=2.01, 95%CI: 1.05-3.86, P=0.036).

In neuroendoscopic surgery via skull base ventral approach for the treatment skull base chordomas in children, the " turtle-back-shaped" surgical strategy of sequential exploration and tumor resection can improve the tumor resection rate. The tumor resection rate is the most important factor in improving the patients prognosis.

To compare and analyze the efficacy of neuroendoscopic transnasal-tuberculum sellae approach and craniotomy in the treatment of tuberculum sellae meningioma.

A retrospective analysis was conducted on the clinical data of 75 patients with grade Ⅰ to Ⅳ sellar nodule meningiomas (craniotomy group) who underwent craniotomy treatment at Neurosurgery Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2014 to September 2018 and 86 patients with grade Ⅰ to Ⅳ sellar nodule meningiomas (neuroendoscopic group) who underwent endoscopic transnasal approach surgery from October 2018 to September 2022 (our center classified tuberculum sellae meningiomas into grades Ⅰ to Ⅴ based on their growth characteristics). The differences in the extent of tumor resection, improvement in visual acuity and visual field, the incidence of postoperative complications, and tumor recurrence rate between the two groups were compared.

The operations were successfully completed in both groups. Compared with the craniotomy group, the neuroendoscopic group had a higher proportion of Simpson grade Ⅰ resection [95.3% (82/86) vs. 70.7% (53/75)]; the neuroendoscopic group had lower incidences of central nervous system infection [1.2% (1/86) vs. 6.7% (5/75)], epileptic seizures [0 (0/86) vs. 12.0% (9/75)] and intracranial hematoma [0 (0/86) vs. 6.7% (5/75)] as well as lower proportion of patients with hypocortisolism on the first day after surgery [12.8% (11/86) vs. 21.3% (16/75)] (all P<0.05). However, there was no statistical difference in the incidence of postoperative cerebrospinal fluid leakage between the two groups (P=0.737). The patient follow-up time was not statistically significant between two groups (median: 31 months and 36 months respectively, P=0.331). Compared with the craniotomy group, the neuroendoscopic group had a higher proportions of patients with the same or improved visual acuity [61.6% (53/86) vs. 45.3% (34/75)] and visual field [60.5% (52/86) vs. 42.7% (32/75)] at 3 months after operation. The tumor recurrence rate in the neuroendoscopy group was lower than that in the craniotomy group [0 (0/86) vs. 12.0% (9/75), P=0.009].

For patients with grade Ⅰ-Ⅳ tuberculum sellae meningiomas, compared with craniotomy, neuroendoscopic surgery via transnasal-tuberculum sella approach has a higher resection rate of Simpson grade Ⅰ resection, lower incidences of central nervous system infections, epileptic seizures, and intracranial hematoma as well as lower recurrence rate of tumors.

To investigate the reliability and safety of using bilateral posterior nasoseptal flaps for skull base reconstruction during endoscopic transnasal resection of pituitary neuroendocrine tumors(PitNET).

We retrospectively analyzed the clinical data of 161 patients who underwent endoscopic transnasal resection of PitNET at the Department of Neurosurgery, Qilu Hospital of Shandong University from January 2021 to June 2022. The patients were divided into the bilateral posterior nasoseptal mucosal flap group (mucosal flap group, n=77) and conventional free graft multiple skull base reconstruction group (free graft group, n=84). The patient′s life quality was evaluated using the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12) and Visual Analogue Scale (VAS). The differences in baseline characteristics, operation time, hospitalization stay, postoperative cerebrospinal fluid (CSF) leakage and other postoperative complications, and life quality were compared between the two groups.

There were no significant differences in baseline characteristics between the two groups (all P>0.05). One case (1.3%) in the mucosal flap group had postoperative CSF leakage, 10 cases(11.9%) in the free graft group had CSF leakage, and the difference was statistically significant (t=1.04, P=0.307). All patients completed follow-up which ranged from 6 to 24 months. There were no significant differences in operation time, hospitalization stay, incidences of postoperative complications except CSF, ASK Nasal-12 or VAS score between the two groups (all P>0.05).

Application of bilateral posterior nasoseptal flaps is a reliable technique of skull base reconstruction that can effectively reduce the incidence of postoperative CSF leakage without significant adverse effects on the duration of surgery and hospitalization, complication rates, or quality of life of PitNET patients.

To explore the efficacy and mechanism of endoscopic third ventriculostomy (ETV) in the treatment of Chiari malformation type Ⅰ(CMⅠ) combined with hydrocephalus.

A retrospective analysis was conducted on the clinical data of 23 patients with CM Ⅰ and hydrocephalus who underwent ETV treatment in the Department of Neurosurgery, General Hospital of the Eastern Theater Command of PLA from July 2013 to July 2022. The clinical efficacy of ETV was evaluated based on the symptom improvement and imaging measurements post operation. Changes in cerebrospinal fluid (CSF) fluid dynamics in the foramen magnum plane and C₁ plane before and after ETV surgery were evaluated using 4D flow MRI. Finite element simulation analysis was used to assess the impact of changes in CSF pressure on the degree of deformation of the cerebellar tonsils before and after simulated ETV surgery.

ETV surgery was successfully performed in all 23 patients, and postoperative CSF cine images indicated success of ETV procedure. The clinical symptoms of the patients were relieved to varying degrees. Two cases of postoperative meningitis were reported. The mean follow-up period for the 23 patients was 13.7±10.1 months. At 6 months postoperatively, the distance of cerebellar tonsillar herniation, Evan index of the lateral ventricle, transverse diameter of the third ventricle, and sagittal diameter of the fourth ventricle were all decreased compared to preoperative measurements (all P<0.05). The effective rate of ETV treatment was 91.3% (21/23). Among patients with associated syringomyelia, 2 cases showed complete disappearance of the syrinx, 3 cases showed significant reduction, and the remaining 7 cases remained stable. The 4D flow MRI examination showed no significant differences in peak velocity, mean velocity, or flow rate through the foramen magnum plane after ETV compared with preoperative measurements (all P>0.05), while peak velocity and flow rate through the C₁ plane were decreased after ETV (both P<0.05). Finite element simulation analysis showed a significant decrease in flow velocity in the third ventricle, aqueduct of Sylvius, and fourth ventricle after simulated ETV, and deformation analysis revealed an upward displacement of the lower edge of the cerebellum by 2.9 mm.

ETV is a safe and effective treatment for CM Ⅰ combined with hydrocephalus possibly through the mechanism of the " bathtub plug" hypothesis.

To investigate the bone healing effect of skull base reconstruction using an in situ bone flap (ISBF) combined with pedicled nasoseptal flap (PNSF) versus free middle turbinate mucosal flap (FMTMF) in surgery via endoscopic extended transnasal approach (EETA).

A retrospective analysis was conducted on the clinical data of 106 patients who underwent EETA surgery with ISBF combined with PNSF or FMTMF for skull base reconstruction at the Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2020. Thin-layer CT scans of the saddle area were performed on the operation day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery, the holographic 3D image modeling/medical image analysis software was applied to perform 3D reconstruction of the bony structures, and measurements were taken to observe the changes in the ratio of the ISBF to the bone window area. Based on the type of mucosal flap used intraoperatively, patients were categorized into the ISBF+ PNSF group (referred to as the PNSF group, n =62) versus the ISBF+ FMTMF group (referred to as the FMTMF group, n=44). The ratio of ISBF to bone window area at different postoperative time points and the percentage of patients with this ratio >90% at 2 years postoperatively were compared between the two groups.

Skull base reconstruction was successfully completed in 106 patients. With the prolongation of postoperative time, the ratio of ISBF to bone window area tended to increase in the patients of both PNSF group and FMTMF group (F=588.62, P<0.001). However, the differences in the ratios of ISBF to bone window area were not statistically significant on the day of operation, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post operation when comparing patients in the two groups (F=0.20, P=0.659); The difference in the percentage of patients with a ratio of ISBF to bone window area >90% at 2 years postoperatively was not statistically significant in the PNSF group compared with the FMTMF group [46.77% (29/62) vs. 50.00% (22/44), χ²=0.11, P=0.743].

Bone healing in EETA surgery using ISBF combined with PNSF or FMTMF for skull base reconstruction seems favorable, and both mucosal flaps ensure survival, growth, and healing of the ISBF.

To preliminarily explore the efficacy of neuroendoscopic transnasal decompression in the treatment of traumatic oculomotor nerve palsy.

A retrospective analysis was conducted on the clinical data of 4 patients with traumatic oculomotor nerve palsy who were treated with neuroendoscopic transnasal decompression at the Department of Neurosurgery, Suzhou Kowloon Hospital, Shanghai Jiao Tong University school of medicine from January 2016 to January 2022. The surgical strategy of decompressing the orbital apex, superior orbital fissure, optic canal, and optic strut was performed in sequence. Three-dimensional CT was reviewed after surgery to clarify the degree and scope of decompression, and the improvement of oculomotor nerve palsy symptoms was followed up.

All 4 patients were successfully operated, and intraoperative and postoperative imaging confirmed that the medial edge of the superior orbital fissure was adequately decompressed. None of the patients had surgery-related complications. During the 1-year follow-up period after surgery, the ptosis symptoms of all 4 patients recovered, and the recovery time was 7 to 30 days. Three patients had complete recovery of eye movements, with recovery time ranging from 7 to 30 days; 1 patient had partial recovery. Three patients had complete recovery of diplopia, with recovery time ranging from 30 days to 6 months; 1 patient had remission. Of the 3 patients with pupil mydriasis, 1 recovered 7 days after surgery and 2 did not recover.

Preliminary research shows that the surgical plan of sequentially decompressing the orbital apex, superior orbital fissure, optic canal, and optic strut under transnasal neuroendoscopy can effectively and safely decompress the oculomotor nerve fissure segment, which can contribute to the recovery of some neurological functions of patients.

To investigate the efficacy, methods and techniques of neuroendoscopic single-nostril transsphenoidal approach in the treatment of incomplete suprasellar Rathke cyst (RCC) in the sellar region. The clinical data of 18 patients with incomplete suprasellar RCC in the sellar area who underwent neuroendoscopic single-nostril transsphenoidal approach in the Department of Neurosurgery of the First Affiliated Hospital of Bengbu Medical College from July 2014 to March 2023 were retrospectively analyzed, including 13 cases with intrasellar growth and 5 cases with intrasellar growth to suprasellar growth. All 18 patients were completely cleared of cystic fluid and intracystic nodules, and partial resection of cystic wall was performed. All the operations were successfully completed. Transient diabetes insipidus occurred in 6 cases, and no complications such as cerebrospinal fluid rhinorrhea, new endocrine dysfunction or death occurred. The postoperative symptoms of 12 patients with headache disappeared; MRI of the pituitary gland showed that the cysts were completely removed 1 month after surgery. Eighteen patients were followed up for (53.0 ± 5.3) months. All 5 patients with optic nerve dysfunction improved 3~6 months after operation; All 8 patients with endocrine dysfunction returned to normal 6 months after operation; All patients had a favorable prognosis by the last follow-up.

To explore the role of mismatch between MR fluid-attenuated inversion recovery sequence vascular hyperintensity (FVH) and diffusion-weighted imaging (DWI) in preoperative evaluation of endovascular thrombectomy (EVT) for acute anterior circulation large vessel occlusion ischemic stroke using perfusion imaging as a reference.

A total of 91 patients with acute anterior circulation large vessel occlusion ischemic stroke who had an onset time of 6 to 24 hours and were admitted to the Neurosurgery Department of Tianjin Huanhu Hospital from May 2020 to October 2021 were retrospectively analyzed. All patients underwent MRI plain scan and perfusion (CT or MR) examination at the same time, and two imaging screening modes were used to determine EVT indications. The criterion for judging EVT indications by MRI plain scan was the presence of FVH-DWI mismatch; for perfusion examination, the criterion for judging EVT indication was a mismatch between the infarct core and the ischemic penumbra. We then evaluated the consistency of two imaging screening modes in determining EVT indications and explored the difference in the rate of good outcome [modified Rankin scale score (mRS) ≤ 2 points] 90 days after surgery for patients screened by the two methods who underwent EVT.

Among 91 patients, 73 (80.2%) of the 91 patients had indications for EVT using FVH-DWI mismatch screening, 49 of whom underwent EVT, and 28 (57.1%) had good outcome 90 days after surgery. After applying perfusion mismatch screening, 75 cases (82.4%) had indications for EVT, 55 of whom underwent EVT, and 28 cases (50.9%) had good outcome 90 days after surgery. A total of 70 patients had both FVH-DWI mismatch and perfusion mismatch, 13 patients had neither FVH-DWI nor perfusion mismatch, 5 patients had perfusion mismatch but no FVH-DWI mismatch, and 3 patients had FVH-DWI mismatch and no perfusion mismatch. There was no statistically significant difference in EVT indications based on FVH-DWI mismatch and perfusion (P=0.724) and there was strong consistency (κ=0.71, 95%CI: 0.52-0.90). There was no statistically significant difference in good outcome rate at 90 days post operation (P=0.660). Those with both FVH-DWI mismatch and perfusion mismatch had the highest proportion of good postoperative outcome, and those with neither FVH-DWI nor perfusion mismatch had the lowest proportion of good postoperative outcome.

The FVH-DWI mismatch in plain MR scan is a simple and reliable method for preoperatively judging EVT indications in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation.

To investigate the observation and clinical significance of multimodal three-dimensional reconstruction combined with microsurgical anatomy on Trolard veins and their anastomotic veins.

The imaging data of 50 patients (100 sides) who underwent three-dimensional contrast enhanced magnetic resonance venography (3D-CEMRV) in the Department of Neurosurgery, Heze Munici-pal Hospital from September 2017 to March 2020 were retrospectively analyzed. Head MRI multimodal image 3D reconstruction models were established in 3D Slicer for T1-weighted imaging of three-dimensional magnetization-prepared rapid gradient-echo sequence, three-dimensional time-of-flight magnetic resonance angiography and 3D-CEMRV sequence. The morphology of Trolard vein and its connecting superficial middle cerebral vein and superficial cerebral vein were observed, and the outer diameter of Trolard vein was measured. The arteries and veins of 20 (40 sides) adult cadaver specimens were injected with red and blue latex, respectively, and the composition of Trolard veins and its connecting cerebral veins were observed under the microscope. At the same time, the outer diameters of Trolard veins were measured.

Based on the three-dimensional image fusion model of the 50 patients (100 sides), 117 Trolard veins were seen in all including 61 Trolard veins on the left side with a mean outer diameter of 1.23± 0.78 mm and 56 Trolard veins on the right side with a mean outer diameter of 1.19± 0.79 mm. There was no statistical significance in the mean outer diameter of the two sides (t=0.28, P=0.784). There were 23 sides (23%) with Trolard vein of single trunk type, 26 sides (26%) with Trolard vein of double trunk type, 14 sides (14%) with Trolard vein of triple trunk type, and 37 sides (37%) without Trolard vein. There were 32 sides (32%) of superficial middle cerebral vein (SMCV) of single trunk type, 62 sides (62%) with SMCV of multiple trunks, and 6 sides (6%) with SMCV of no obvious formation. The minimum diameter of the superficial cerebral vein and its anastomotic veins was 1 mm. In the microanatomical observation of 20 cadaver head specimens (40 sides), there were 41 Trolard veins in total, 22 on the left with a diameter of 1.06±0.61 mm, and 19 on the right with a diameter of 1.13±0.59 mm. There was no statistically significant difference in the diameter of lateral veins (t=0.37, P=0.712). There were 15 sides(37.5%) with Trolard veins of single trunk type, 10 sides (25.0%) with double trunk type, 2 sides (5.0 %) with triple trunk type, and absent type on 13 sides (32.5%). The SMCV of single trunk type was found on 14 sides (35.0%), multiple trunk type on 23 sides (57.5%), and no obvious formation on 3 sides (7.5%). It was revealed under the microscope that the minimum diameter of the superficial cerebral vein and its anastomotic veins was 0.5 mm. There was no statistically significant difference in the diameter of the left or right Trolard vein between microscopic observation and three-dimensional reconstructed model (both P>0.05).

The anatomical structure of the Trolard vein varies greatly. The three-dimensional image reconstruction model can clearly display the Trolard vein in most cases and its anastomotic veins, which can make up for the shortcomings of microanatomy.

To investigate the clinical characteristics and surgical results of familial tight terminale syndrome.

A retrospective analysis was conducted on the clinical data of 32 children with tight filum terminale syndrome from 16 families who were diagnosed and treated in the Department of Neurosurgery, Children′s Hospital of Soochow University from January 2017 to December 2021. All of the patients had first-degree relative (sibling) involvement. A total of 23 children underwent tethered cord release via unilateral intervertebral approach, including 18 cases of filum terminale lipidation type and 5 cases of filum terminale fibrosis type. The clinical features and surgical outcomes of the children were analyzed.

Of the 32 children, M/F ratio was 17/15. Patients were all males in 6 families and females in 5 families. The median age was 4 years and 2 months (range: 11 months-13 years and 6 months). Twelve patients (38%) had defecation and urination disorders, including 1 patient (3%) with lumbar and leg pain. One patient (3%) had recurrent urinary tract infections. Nineteen patients (56%) had no clinical symptoms. Abnormal lumbosacral skin changes were present in 13 patients (41%). Seven patients (22%) had other systemic diseases. Among them, 10 (31%) children in 5 families had enuresis as the initial symptom, and 6 (19%) children in 3 families had abnormal lumbosacral skin changes. MRI showed that 20 (62%) had filum terminale lipidation, 12 (38%) had filum terminale fibrosis, and 24 (75%) children in 12 families had the same type of filum terminale lesion. The conus medullaris was located in L₁ in 18 patients, L₂ in 12, and T₁ in 22, and 20 (63%) children from 10 families had the common position of conus medullaris (T₁₂-L₂). In 23 patients treated surgically, MRI showed that the filum terminale was severed and there was no adhesion at 3 to 6 months post surgery. The median follow-up time of clinical symptoms was 15 months (range: 3-30 months). Of the 10 children with preoperative symptoms, 8 were cured or significantly improved after surgery. None had new symptoms of neurological deficits.

The tight filum terminale syndrome has a familial genetic predisposition, and children from the same family have some of the same clinical manifestations. Surgical treatment is safe and can effectively improve the symptoms of neurological deficits caused by tethered cord syndrome.

To explore the surgical methods and therapeutic effects of microsurgical clipping of ruptured non-bifurcation aneurysms of the M1 segment of the middle cerebral artery (MCA).

A retrospective analysis was performed on the clinical data of 22 patients with ruptured MCA M1 segment non-bifurcation aneurysms who underwent microsurgical clipping at the Department of Neurosurgery, Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2014 to December 2021. Those cases accounted for 10.6%(22/208) of MCA aneurysms treated during the same period at the department. Twenty-two patients underwent surgical treatment through the transpterional approach or frontolateral approach. Regular clinical follow-up was performed after surgery. The patient′s outcome was evaluated by Glasgow Outcome Scale (GOS) and the recurrence of aneurysm was evaluated based on the imaging follow-up.

The aneurysms of 22 patients were all clipped. Among them, 5 cases of aneurysms ruptured during the operation and were successfully clipped after the proximal end of the parent artery was temporarily blocked. Follow-up CT scans 12 to 24 hours after surgery showed cerebral infarction in 2 cases and mild ventricular dilation in 1 case. CT angiography (CTA) was reviewed 2 to 3 weeks after surgery, which showed that there was some residual neck of aneurysm in 1 case. After 9 to 12 months of follow-up, head CT, CTA or digital subtraction angiography was performed. It was found that 1 case had a small amount of residual aneurysm without significant changes, and the remaining 21 cases had no aneurysm recurrence. During the follow-up period, 1 case developed hydrocephalus and recovered well after ventriculo-peritoneal shunting. As of the last follow-up, there were 18 cases of GOS grade Ⅴ, 2 cases of grade Ⅳ, 1 case of grade Ⅲ, and 1 case of grade Ⅱ.

Preliminary research shows that microsurgical clipping for the treatment of ruptured MCA M1 segment non-bifurcation aneurysms is associated with a high proportion of good outcome, a low incidence of surgery-related complications, and seems safe and effective.

To determine the prognosis and its influencing factors of stereoelectroence-phalography(SEEG)-guided radiofrequency thermocoagulation(RFTC) for the treatment of drug-refractory epilepsy.

The clinical data of 36 patients with drug-refractory epilepsy treated in the Department of Neurosurgery of the Second Hospital of Lanzhou University from June 2019 to June 2021 were analyzed retrospectively. SEEG electrode implantation scheme was designed in all patients, and the onset area of seizure was determined based on SEEG monitoring information and then RFTC was performed. The patients were followed up by telephone or outpatient service after operation, and the outcome was evaluated by using Engel grading system. Univariate analysis and multivariate logistic regression analyses were used to explore the factors influencing the outcomes of patients with drug-refractory epilepsy.

Thirty-six patients were followed up for 13.7±6.9 months (range: 6-32 months) after RFTC treatment. The seizure-free rates at 2, 12 and 24 months after RFTC were 58.3% (21/36), 30.0% (6/20) and 14.3% (1/7) respectively. The results of the last follow-up showed that the outcome was good (Engel grades Ⅰ and Ⅱ) in 17 cases (47.2%) and poor (Engel grades Ⅲ and Ⅳ) in 19 cases (52.8%). Univariate analysis showed that no secondarily generalized tonic-clonic seizures, obvious lesions showed on MRI, obvious hypometabolic areas on positron emission tomography (PET) results, SOP1 and SOP2 patterns of epileptic seizure and disappearance of interictal discharge on 24-h SEEG after thermocoagulation may be associated with the good outcome of the patients. Multivariate logistic analysis showed that clear focus (OR=40.41, 95%CI: 2.26-721.27, P=0.012) on MRI, obvious hypometabolic area (OR=26.88, 95%CI: 1.40-517.65, P=0.029) on PET and the disappearance of interictal discharge on 24-h SEEG after thermocoagulation (OR=15.14, 95%CI: 1.57-146.30, P=0.019) were independent influencing factors of good prognosis.

SEEG-guided RFTC has obvious short-term therapeutic effect for the treatment of refractory epilepsy. Clear epileptogenic focus on MRI, hypometabolic area on PET results and interictal discharge disappearance after thermocoagulation suggest a good prognosis in patients with drug-refractory epilepsy treated with RFTC.

The clinical data of 223 patients with limb spasticity who underwent surgical treatment in the Department of Neurosurgery, Yuquan Hospital, Tsinghua University from November 2020 to May 2023 were retrospectively analyzed. Ashworth scale (AS) and surface electromyography (sEMG) scores were used to assess muscle tone in lower extremity muscle groups, respectively. The correlation of the two assessment methods was analyzed by Gamma test, and the results showed that the Gamma values of the quadriceps, hamstrings, adductors and triceps muscle tone scores were 0.48, 0.68, 0.59 and 0.47, respectively, in a total of 223 patients (435 sides). Seventy-eight patients were randomly selected and evaluated by two evaluators with AS and sEMG scores, respectively. By weighted Kappa analysis, the consistency of the two evaluation methods groups (different evaluators) was compared. The results showed that the Kappa values of 151 lateral quadriceps, hamstrings, adductors and triceps muscles were 0.39, 0.32, 0.25 and 0.55, respectively, while the Kappa values of sEMG scores were 0.77, 0.87, 0.83 and 0.50, respectively. The results of preliminary studies showed that the application of sEMG to assess the muscle tone of lower limb muscles in patients with limb spasticity was effective and reliable.

The incidence of distal middle cerebral artery aneurysm is extremely low, its tumor body is small and easy to rupture, and it is difficult to diagnose it based on imaging examination alone. The Neurointervention Center of Nantong University Affiliated Hospital treated a patient with left temporal lobe hemorrhage in December 2022. The patient's head CT and digital subtraction angiography results were fused by 3D Slicer software, and it was confirmed that he was a left middle cerebral artery M4 segment aneurysm with ruptured hemorrhage, and then treated with endovascular embolization. After 2 months follow-up, the patient's right limb muscle strength recovered from preoperative grade II to grade IV, and the modified Rankin scale score was 0.

Brain glioma is a malignant tumor originating from neuroepithelial tissue, characterized by nuclear abnormality, high proliferation and necrosis of tumor cells, microvascular proliferation and pleomorphic vessels. At present, the main treatment is surgical resection with radiotherapy and chemotherapy, but the drug resistance of tumors is increasing year by year. Tumor microenvironment is fundamental to the survival of tumor cells. Therefore, it is of great significance to understand the composition of glioma microenvironment and its regulation of tumor cell metabolism. In this paper, the composition of glioma microenvironment and its metabolism and regulation of tumor were reviewed, so as to explore the feasibility of interfering with tumor microenvironment and targeting metabolic regulators in the treatment of glioma.

γδ T cells are the "bridge" between natural immunity and acquired immunity. In recent years, the anti-tumor and anti-infection studies of γδ T cells have shown that γδ T cells have important functions and clinical application value in tumor immunity and infection immunity. Among them, V γ 9V δ 2 subset is a class of γδ T cells only existing in human peripheral blood. Although its number is small, its function is comprehensive and powerful. Compared with the function of autologous γδ T cells in tumor patients, which are inhibited or "acquired deficiency", allogeneic γδ T cells derived from healthy people have stronger clinical application value because of their healthy function. In this paper, the biological characteristics of human γδ T cells, the mechanism of recognizing tumor cells, the different roles in immunity and its clinical value were reviewed for the application of γδ T in anti-malignant brain tumors.

Intracranial germ cell neoplasms (GCTs) are rare germ cell-derived tumors, which have diverse therapeutic modalities due to their complex tissue composition. Intracranial GCTs are classified into germ cell tumors and non-germ cell tumors. Germ cell tumors are tumors that can be highly cured by multimodal therapy, but non-germ cell tumors have poor survival outcomes. At present, the treatment plan for intracranial GCTs is not uniform, and there is a lack of clear clinical diagnosis and treatment guidelines. This article reviews the experience and progress in the treatment of intracranial GCTs, in order to provide reference for the clinical treatment decision of this disease.

With the emergence of composite operating room, the application of composite surgical technology in the surgical field is more and more extensive, especially in the treatment of complex and difficult neurosurgical related diseases. This article reviewed the relevant literature on the application of compound surgery technique in complex neurosurgical diseases such as cerebrovascular diseases and intracranial tumors, and analyzed the advantages of applying compound surgery technique in the compound operating room to treat this kind of diseases in the first stage, which is helpful to promote this technique in medical centers with conditions and improve the clinical efficacy of patients.