Volume 40 · Issue 01 · 2024

"Last night, we fought back to the north, and now we are in the east." On the occasion of 2024, on behalf of the editorial board and all members of the editorial department of Chinese Journal of Neurosurgery, I would like to sincerely thank every editorial board, reviewers, readers and authors. It is everyone's support and love that has made this journal achieve excellent results, made neurosurgery develop rapidly, and made patients with neurological diseases get better and better diagnosis and treatment.

Deep brain electrical stimulation (DBS) has become a key technology for the treatment of functional brain diseases since its inception for more than 30 years. With the cross-fusion of multidisciplinary technologies, DBS technology continues to innovate, and its therapeutic scope continues to expand, which gives birth to new research opportunities. However, DBS still faces challenges in the analysis of its mechanism of action, the design of personalized treatment protocols, and the development of closed-loop stimulation systems. This paper reviews the new progress of DBS technology, the current challenges and the innovative treatment strategies brought about by the intersection of medicine and engineering, especially the combination of brain-computer interface and DBS technology.

To comparatively analyze the differences in therapeutic efficacy between remote programming and traditional programming methods after deep brain stimulation (DBS) surgery for patients with dystonia and to identify the advantages of remote programming.

A retrospective comparative analysis was conducted on the clinical data of 29 patients who underwent DBS for dystonia and received remote programming within one year postoperatively (remote programming group) at the Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences from July 2020 to August 2022. The group was compared with a control group of 20 patients who underwent DBS from July 2013 to September 2016 and received traditional in-person outpatient programming postoperatively (traditional programming group). Preoperative and one-year postoperative scores on the Burke-Fahn-Marsden dystonia rating scale-movement (BFMDRS-M) and disability (BFMDRS-D) were documented. The improvement rates were compared between the two groups of patients to evaluate the degree of improvement in patients′ muscle function disorders. Subgroups were formed based on the electrode implantation target, namely GPi and STN subgroups, and differences in the improvement rates in BFMDRS-M, BFMDRS-D scores and programming sessions between those subgroups and different programming groups within the same subgroup were analyzed.

There were no statistically significant differences in baseline data, including age, gender, preoperative duration of illness, electrode implantation target, distance from residence to the hospital, preoperative BFMDRS-M and BFMDRS-D scores between the two groups (all P>0.05), which indicated comparability of the two groups. Compared to the traditional programming group, the remote programming group showed a significant reduction in programming costs[M(Q₁, Q₃), 3 344(1 541, 5 183) yuan vs. 5 313(2 953, 10 773) yuan, Z=-2.16, P=0.031]. There were no statistically significant differences in the improvement rates of BFMDRS-M and BFMDRS-D scores between the two groups (both P>0.05). Subgroup analysis results showed that in both remote programming and traditional programming groups, there were no statistically significant differences in the improvement rates of BFMDRS-M and BFMDRS-D scores, remote programming sessions(only remote programing group data comparison), or total programming sessions between the GPi and STN subgroups (all P> 0.05). Within the GPi and STN subgroups, the remote programming group showed no significant differences in the improvement rates of BFMDRS-M and BFMDRS-D scores compared with traditional programming group (all P>0.05), while the total programming sessions were significantly higher in the remote programming group than in the traditional programming group (both P<0.05).

Remote programming is a feasible programming strategy for patients with dystonia after DBS. It can reduce economic costs while ensuring clinical efficacy.

To explore the clinical efficacy of deep brain stimulation (DBS) in the treatment of Tourette syndrome (TS), and to preliminarily observe the difference in the effects of targeting the globus pallidus interna (GPi) and the centromedian-parafascicular complex (CM-Pf) on the symptom improvement of TS.

The clinical data of 40 TS patients who received DBS at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from October 2006 to January 2023 were retrospectively analyzed. Among them, 33 cases were in the GPi-DBS group and 7 cases were in the CM-Pf-DBS group. The improvement of clinical symptoms of the patients was followed up 6 and 12 months after surgery. The main evaluation index of clinical symptoms was the Yale Global Tic Severity Scale (YGTSS) score, and the secondary evaluation indexes were the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HRDS), Hospital Anxiety and Depression Scale (HADS) and Yale-Brown Obsessive Compulsive Scale (YBOSC). Comparative analysis of the improvement of YGTSS scores were conducted between the two groups.

The YGTSS scores of 40 patients before surgery, 6 months after surgery, and 12 months after surgery were 63.6±14.2 points, 42.0±15.0 points, and 36.1±16.9 points respectively, and the differences were statistically significant (P<0.001). The improvement rates of YGTSS scores 6 and 12 months after surgery were (33.7±19.0)% and (43.1±23.3)% respectively. BDI (24 cases), HDRS (24 cases), HADS (25 cases), and YBOCS (14 cases) scores also showed a decreasing trend at 6 months and 12 months post surgery (all P<0.05). Compared with the CM-Pf-DBS group, there was no statistical significance in the improvement of YGTSS scores at 6 or 12 months after operation in the GPi-DBS group or the CM-Pf-DBS group (both P>0.05). In addition, 5 patients in the GPi-DBS group developed symptoms of nausea, vomiting or dyskinesia after turning on the device.

DBS can improve tic symptoms, anxiety and depression in TS patients, and the improvement rate tends to increase with the prolongation of postoperative follow-up. Preliminary observations show that there is no significant difference between GPi-DBS and CM-Pf-DBS in improving tic symptoms.

To preliminarily explore the application of Percept PC in the treatment of Parkinson′s disease (PD) with deep brain stimulation (DBS) of the subthalamic nucleus (STN), and to compare the effect on initial programming with Lead-DBS imaging technology.

A retrospective study was conducted on 15 patients with primary PD who received STN-DBS at the Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital and the Neurosurgery Department of two other hospitals from January 2023 to September 2023. Among them, there were 5 cases in the Percept PC group and 10 cases in the Lead-DBS group. In the Percept PC group, the programmed contacts were chosen based on the monitored electrophysiological information, and the contacts with the highest local field potential (LFP) amplitude in the beta frequency band were used as the active contact in initial programming. In the Lead-DBS group, Lead-DBS imaging software was used to assist in choosing active contacts located in the targets and performing initial programming with the traditional method. We then observed the recording status of Percept PC and compared the initial programming of the two groups.

In 5 patients in the Percept PC group, the Timeline function was turned on after surgery, and the LFP change of the micro-lesion effect was recorded in all case. The LFP fluctuations were observed through the Survey function and Streaming function. The clinical symptoms of all 5 patients were improved after determining the active stimulation contacts and currents. In initial programming, the programming time of the Percept PC group and the Lead-DBS group were 44.0±4.2 min and 63.9±6.2 min respectively; the median (Q₁, Q₃) number of adverse reactions during the test was 0 (0, 1) times and 2 (1, 3) times, and the differences were statistically significant (both P<0.05). After turning on the device, the improvement rate of the score assessed based on the third part of the Unified Parkinson′s Disease Rating Scale in the Percept PC group and the Lead-DBS group was (65.2±7.3)% and (75.4±18.7)% respectively; the median (Q₁, Q₃) reduction rate of equivalent dose of levodopa after surgery in the Percept PC group and the Lead-DBS group was 37.2% (7.1%, 44.8%) and 28.9% (11.0%, 42.5%) respectively, and the differences were not statistically significant (both P>0.05).

The application of Percept PC in STN-DBS treatment of PD can effectively alleviate the clinical symptoms of patients by selecting programmed contacts through brain sensing function. Compared with Lead-DBS imaging technology-assisted programming, Percept PC is associated with shorter initial programming time and less occurrence of adverse reactions.

To observe and analyze the improvement effect of deep brain stimulation (DBS) of the posterior subthalamic area (PSA) and ventral intermediate nucleus of the thalamus (Vim) on motor and non-motor symptoms in patients with essential tremor (ET).

A retrospective study was conducted on patients who underwent PSA-DBS (5 cases) and Vim-DBS (9 cases) at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from November 2018 to April 2022. The Clinical Rating Scale for Tremor (CRST) was used to evaluate tremor symptoms (motor symptoms); the Quality of life in Essential Tremor Questionnaire (QUEST) was used to evaluate the quality of life, the Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD) were used to evaluate the patient′s anxiety and depression respectively, and the Voice Handicap Index (VHI) was used to assess the voice impairment (all non-motor symptoms). We then compared the improvement of the above indicators between the two groups of patients before surgery and at the last follow-up after surgery, with P<0.05 indicating significant difference.

There was no statistically significant difference in the above-mentioned indicators between the two groups of patients before surgery (all P>0.05). The median (Q₁, Q₃) follow-up time in the postoperative PSA-DBS group and Vim-DBS group were 18 (14, 30) months and 12 (12, 30) months respectively (P=0.245). At the final follow-up, the CRST scores of the two groups of patients were improved compared with those before surgery (both P<0.05). The median (Q₁, Q₃) improvement rate in the PSA-DBS group was 64.3% (56.0%, 85.4%) and that in the Vim-DBS group was 27.3% (17.2%, 36.0%), and the difference between the two groups was statistically significant (P=0.019). The QUEST score in the PSA-DBS group improved compared with preoperative period (P=0.032), with a median (Q₁, Q₃) improvement rate of 62.5% (28.6%, 65.7%), while the improvement rate in the Vim-DBS group was -4.17% (-41.7%, 27.3%), which was not improved compared with before surgery (P=0.487), and there was statistically significant difference in the improvement rate in QUEST score between the two groups (P=0.042). There was no significant difference in the intra-group and inter-group HAMA, HAMD and VHI scores between the PSA-DBS group and the Vim-DBS group before and after surgery (all P>0.05).

Preliminary research shows that both PSA-DBS and Vim-DBS can improve the motor symptoms of ET patients, but the overall effect on non-motor symptoms is not ideal. The overall effect of PSA-DBS seems superior to that of Vim-DBS.

To investigate the clinical effect and preliminary experience of programming and rehabilitation after deep brain stimulation for Parkinson′s disease (PD) patients with gait disorder assisted by an exoskeleton system.

A total of 10 patients with PD with fluctuating gait disorder symptoms after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in the Department of Functional Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University from June 2019 to June 2023. Before operation, Hoehn-Yahr grade 2.5 was reported in 2 cases, 3.0 in 5 cases, and 4.0 in 3 cases. The exoskeleton system was used for force feedback training and gait posture correction training, and the gait data was monitored for DBS programming. The paired t-test was used to compare and analyze the swing phase of both lower limbs, stride length, velocity and cadence of both lower limbs before the first training and after the last training to evaluate the efficacy.

All 10 patients were trained with the lower limb exoskeleton system to adjust the DBS programming parameters, and each round of training was 4 times with a total of 2-4 rounds. Compared with before the first training, the swing phase in both lower limbs increased after the last training [(27.57±2.39)% vs. (24.30±2.75)% on the left side; (27.38±2.96)% vs. (23.15±2.77)% on the right side], the stride length of both lower limbs increased (0.83±0.16 m vs. 0.55±0.18 m on the left side; 0.83±0.16 m vs. 0.55±0.17 m on the right side), the velocity increased (0.73±0.18 m/s vs. 0.46±0.14 m/s), and the difference was statistically significant (all P<0.05), while the cadence was not significantly improved (106.80±15.50 steps/min vs. 103.84±10.53 steps/min, P=0.559).

Preliminary studies have suggested that the application of lower limb exoskeleton system to assist postoperative programming and rehabilitation therapy of DBS in PD patients can improve the gait disorder of patients to a certain extent.

To explore the impact of intracranial air (ICA) on the electrode implantation accuracy and clinical efficacy of neurosurgical robot-assisted deep brain stimulation (DBS) in the treatment of Parkinson′s disease (PD).

A retrospective analysis was conducted on the clinical data of 292 PD patients who underwent bilateral neurosurgical robot-assisted DBS surgery at the Department of Neurosurgery, the General Hospital of Northern Theater Command from February 2017 to May 2022, including 95 cases of local anesthesia and 197 cases of general anesthesia. There were 193 cases of electrodes implanted into bilateral subthalamic nucleus (STN) and 99 cases into the bilateral globus pallidus interna (GPi). The postoperative fused CT images were used to measure and analyze the electrode displacement and electrode tip excursion 2 hours and 1 week after surgery. We then calculated the ICA volumes, which were divided into three categories: <10 cm^3, 10-25 cm^3, and >25 cm³ subgroups. The differences in electrode implantation accuracy of those tree categories were analyzed at 2 hours and 1 week after surgery (number of cases: 188, 71, 33, respectively), for STN target (number of cases: 123, 48, 22, respectively) and for GPi target (number of cases: 65, 23, and 11, respectively). The improvement rate of the Unified PD Rating Scale Part Ⅲ (UPDRS-Ⅲ) score at 12-month follow-up and the differences in programming voltages and outcomes at different targets were analyzed.

The operations of all 292 patients were successfully completed, and there were no postoperative complications such as intracranial infection or bleeding. The ICA volume of all patients was 7.3±0.6 cm^3, and there was no statistically significant difference in ICA volume between the first side and the second side, men and women, GPi and STN target patients (all P>0.05). The difference in ICA volume between patients under local anesthesia and general anesthesia was statistically significant (t=6.12, P<0.001). The electrode displacement characteristic model showed that the electrode bent backward 2 hours after surgery and returned to straightness 1 week after surgery. There was no statistically significant difference in the X-axis and Y-axis offset distance between the first and second sides of the electrode tip 2 hours and 1 week after surgery (all P>0.05). There was no difference in the X-axis offset distance on the same side (both P>0.05), and the differences in Y-axis offset distance were all statistically significant (both P<0.001). The electrode implantation accuracy of 292 patients was 0.75±0.35 mm. There were statistically significant differences in the electrode implantation accuracy of the STN target and GPi target among the three subgroups at 2 hour and 1 week after surgery (all P<0.001). Among them, the increase in accuracy of GPi target electrode implantation(the difference value between 2 hours and 1 week after surgery) in the ICA>25 cm³ subgroup was higher than that of the STN target, and the difference was statistically significant (0.46±0.21 mm vs. 0.28±0.18 mm, t=2.56, P=0.016). All 292 patients received clinical follow-up 12 months after surgery. The UPDRS-Ⅲ score improvement rate was 59.3%±17.9%. The postoperative programmed voltage was 2.42±0.40 V for the STN target and 3.88±0.56 V for the GPi target. There was no statistical significance in the UPDRS-Ⅲ score improvement rate or the programmed voltage for the STN target among the three subgroups (all P>0.05), while the difference in the programmed voltage for the GPi target was statistically significant (Z=17.64, P<0.001). During the programming process, 72 patients experienced adverse reactions such as dizziness and dyskinesia, among which the ICA>25 cm³ subgroup accounted for the highest proportion(44.4%, 32/72). After treatments such as programming adjustment of voltage parameters, the symptoms improved.

ICA will cause electrode deformation and electrode tip displacement after neurosurgical robot-assisted DBS treatment of PD, affecting the electrode implantation accuracy. When the ICA volume is >25 cm^3, it is difficult to restore the electrode implantation accuracy when selecting the GPi as target. Although the target of GPi can be selected to improve the motor symptoms of PD patients, the voltage required for programming is higher and there might be more adverse reactions.

To explore the clinical effect of 3D-FLAIR MRI sequence for targeting the subthalamic nucleus (STN) used in the deep brain stimulation (DBS) for the treatment of Parkinson′s disease (PD).

A prospective study was conducted on 40 PD patients who underwent bilateral DBS surgery at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from March 2021 to September 2022. According to simple randomization method, 20 patients received T2-weighted image (T2WI) scan to target STN (T2WI group), while the other 20 patients underwent 3D-FLAIR sequence (3D-FLAIR group) scan. The contrast ratio of the STN and its surrounding normal white matter as well as the radial error on the plane parallel to anterior commissure-posterior commissure (AC-PC) plane after electrode implantation were calculated. The baseline data before surgery, the contrast ratio, the score of part Ⅲ of Unified Parkinson′s Disease Rating Scale (UPDRS-Ⅲ) after 6 months of surgery and its improvement rate were compared between the two groups.

There were no significant difference in the gender, surgical age, disease duration, pre-surgical UPDRS-Ⅲ score (Med-on, Med-off) between the two groups (all P>0.05). The contrast ratio of STN and its surrounding normal white matter was higher in 3D-FLAIR group than that in T2WI group (0.48±0.10 vs. 0.34±0.11, t=-4.49, P=0.001). In the radial error of implanted electrodes, the UPDRS Ⅲ score (Med-off) or motor score improvement rate at 6 months post turning on of the stimulator, there were no significant differences between the two groups (all P>0.05).

In pre-surgical localization of the STN on MRI, the electrode implantation accuracy and clinical efficacy after DBS of the 3D-FLAIR and T2WI groups were comparable, but the contrast between STN and the surrounding white matter was higher and the STN was easier to identify by 3D-FLAIR.

To analyze the influencing factors of sleep disorder improvement in patients with Parkinson′s disease (PD) 1 year after deep brain stimulation (DBS), and to construct a nomogram model that can effectively predict the improvement of patients′ sleep quality after surgery.

A retrospective analysis was performed on the clinical data and questionnaire survey results of 333 PD patients who received DBS (STN-DBS) targeting the subthalamic nucleus (STN) at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2020 to August 2022. According to whether the PD Sleep Scale (PDSS) score improved 1 year after surgery, 333 patients were divided into a sleep disorder improvement group and a non-improvement group. Univariate and multivariate logistic regression analyses were used to screen factors affecting the improvement of patients′ sleep disorders 1 year after surgery, and a nomogram model was established to predict the improvement of patients′ sleep disorders. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the discrimination and fitting performance of the prediction model.

Compared with the patients in the group whose sleep disorder did not improve after surgery, the patients in the group whose sleep disorder improved had better preoperative drug improvement rate, Mini-Mental State Examination (MMSE) score, and Hamilton Anxiety Rating Scale (HAMA) score, while they had worse PDSS score (all P<0.05). Further univariate and multivariate logistic regression analyses showed that the improvement rate of preoperative medication (OR=0.00, 95%CI: 0.00-0.00, P=0.002), preoperative MMSE score (OR=0.78, 95%CI: 0.71-0.86, P<0.001), preoperative HAMA score (OR=1.15, 95%CI: 1.06-1.25, P=0.001) and preoperative PDSS score (OR=1.03, 95%CI: 1.00-1.06, P=0.004) were independent risk factors for postoperative sleep disorder improvement in PD patients. A nomogram model was established based on independent risk factors, and the area under the ROC curve was 0.78 (95%CI: 0.69-0.88); the DCA results showed good fit between the predicted values of the nomogram and the actual observed values.

The nomogram model established in this study has certain value in predicting the improvement of sleep quality in PD patients 1 year after STN-DBS surgery.

To investigate the relationship between the position of the superior petrosal vein and the trigeminal nerve during microvascular decompression (MVD) for primary trigeminal neuralgia and the corresponding management strategies.

The clinical data of 69 patients with primary trigeminal neuralgia treated by the same surgeon at the Department of Neurosurgery, China-Japan Friendship Hospital from October 2022 to March 2023 were retrospectively analyzed. The relative positional relationship between the superior petrous vein and the trigeminal nerve was divided into three types. Type Ⅰ was crossed type, type Ⅱ was concomitant type, and type Ⅲ was parallel type. For type Ⅰ patients, the arachnoid membrane between the superior petrosal vein and the trigeminal nerve and/or tentorium cerebellum was fully dissected and separated. The offending vessels in the first space should be decompressive through this space. For type Ⅱ patients, the superior petrous vein was separated from the arachnoid membrane of the trigeminal nerve and its nerve root entry/exit zone of the brainstem (REZ) as far as possible, and cotton pad was placed to isolate it. For type Ⅲ patients, the superior petrosal vein was gently pushed away with an aspirator, and the first space was completely exposed for decompression. The outcome was assessed by the Barrow Neurological Institute (BNI) pain scale. The BNI classification of patients was followed up by outpatient visits and telephone interviews from discharge to the end of follow-up.

Among 69 patients, 52.2% (36 cases), 30.4%(21 cases) and 17.4% (12 cases) were type Ⅰ, type Ⅱ and type Ⅲ respectively. The superior petrosal vein was completely preserved during MVD. Within 7 days after operation, there were 68 cases of BNI grade Ⅰ and 1 case of BNI grade Ⅱ. No complications such as hearing disorder or venous drainage disorder occurred after operation. The follow-up time [median (Q₁, Q₃)] of 69 patients was 6 (4, 7)months. At the last follow-up, the symptoms of trigeminal neuralgia were completely disappeared in all patients (BNI grade Ⅰ).

According to the different position relationship between the superior petrosal vein and the trigeminal nerve, the corresponding surgical strategy should be adopted to preserve the superior petrosal vein as completely as possible, which can not only relieve trigeminal neuralgia, but also avoid the occurrence of complications related to the injury of the superior petrosal vein.

To explore the safety and effectiveness of balloon-assisted embolization of anterior skull base dural arteriovenous fistula (DAVF) through different blood supply arteries.

The clinical data of 9 patients with anterior skull base DAVF who underwent balloon-assisted embolization at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2002 to December 2022 were retrospectively analyzed. Nine patients underwent balloon-assisted Onyx glue embolization via the sphenopalatine artery, ophthalmic artery, and middle meningeal artery respectively, with 10 procedures in total. During the operation, complete occlusion of the proximal drainage vein by the embolic agent was considered as the criterion for immediate complete embolization. The safety of the procedure was evaluated based on the patient′s comorbidity profile. Clinical follow-up was performed after surgery, and the modified Rankin Scale (mRS) was used to evaluate the clinical outcomes of the patients. Imaging follow-up was performed through digital subtraction angiography (DSA) examination to determine whether the fistulas recurred.

Seven of the 9 fistulas were completely embolized, and two were nearly completely occluded. One of the nine patients had central retinal artery ischemia after embolization via the ophthalmic artery, while the remaining 8 patients had no complications. All 9 patients were followed up for a period ranging from 59 to 127 months. The mRS was 0 in 7 cases and 1 in 2. Six patients performed imaging follow-up for a period ranging from 6 to 71 months. More than 3 months later, the patient with near-total occlusion received the examination of DSA, which indicated that the fistula was self-occluded. After complete embolization, 5 patients underwent DSA review, and none had recurrence.

When a microcatheter is unable to reach the fistula in an anterior cranial fossa DAVF, balloon-assisted Onyx embolization is feasible and effective treatment with minor complications.

To explore the predictive value of a multiparametric radiomic model based on MRI images for molecular subtypes of adult diffuse gliomas including isocitrate dehydrogenase (IDH) mutation, IDH wild type, and IDH mutant 1p/19q co-deletion subtypes.

The clinical data and preoperative multiparametric MRI data of patients with diffuse gliomas pathologically diagnosed after craniotomy at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University (dataset with 1: 465 cases) and the Department of Neurosurgery, Henan Provincial People′s Hospital (dataset with 2: 137 cases) from January 2011 to September 2021 were collected. The optimal radiomic features were extracted and selected. Then, the radiomic model was constructed using combined algorithms including Boruta and Random Forest. Dataset 1 was randomly divided into a training set and an internal validation set according to the proportion of 7 ∶3 for machine learning. And dataset 2 was an independent external validation set. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC), sensitivity, specificity values were evaluated to assess the classification performance of radiomic model predicting three molecular subtypes of adult diffuse gliomas.

Among the dataset 1, there were no significant differences in sex, age, molecular subtypes of gliomas, or WHO grade between the training set (332 cases) and the internal validation set (133 cases, all P>0.05). And there were no significant differences for above clinical datas between dataset 1 (465 cases) and dataset 2 (137 cases, all P>0.05). A total of 8 texture features and 13 intensity features from MRI were significantly correlated with the molecular subtypes of adult diffuse gliomas. The AUC values of IDH mutation, IDH wild type, IDH mutant 1p/19q co-deleted subtypes of the internal validation set were 0.81, 0.86, and 0.85, respectively. The sensitivity values were 89.5%, 69.4%, and 75.0%, respectively. And the specificity values were 63.2%, 91.4%, and 82.9%, respectively. In the external validation set, the AUC values of IDH mutation, IDH wild type, and IDH mutant 1p/19q co-deleted subtypes were 0.76, 0.82, and 0.81, respectively. The sensitivity values were 75.0%, 67.3%, and 72.2%, respectively. And the specificity values were 64.6%, 78.6%, and 79.8%, respectively.

The multiparametric radiomic model has high value in prediction of molecular subtypes of adult diffuse gliomas.

To establish a C-arm X-ray foramen ovale (FO) imaging method and conduct clinical verification.

The imaging data of patients (virtual imaging group, 90 cases) who visited the outpatient clinic at the Department of Neurosurgery, the Second Affiliated Hospital of Zhengzhou University and received cranial thin-section CT scans from June 2020 to December 2022 were collected. Simulated imaging of the FO was made based on three-dimensional reconstruction of head CT images. Patients with primary trigeminal neuralgia who underwent percutaneous puncture and balloon compression of the semilunar ganglion of trigeminal nerve at the Department of Neurosurgery of the Second Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were prospectively enrolled into this study (real puncture group, 12 cases). C-arm X-ray foramen ovale imaging was performed during the operation. The patient was placed in a supine position. Three points were marked: point A at the lower extreme of the nasal columella and points B and C at the intersection of the lateral margin of the orbit with an extension line of the zygomatic arch. The C-arm was rotated along a horizontal axis until points B, A, and C visually aligned. After confirming in fluoroscopy that point A essentially coincided with the line between the outermost of the bilateral infraorbital margins, the C-arm was rotated towards the puncture side in 20-25° for obtaining an image of FO. The imaging outcomes of the FO were divided into three categories: Ⅰ (complete and clear visualization), Ⅱ (partial visualization), and Ⅲ (slit-like visualization). The consistency of Class Ⅰ visualization of the FO under simulated X-ray fluoroscopy and CT images in the virtual imaging group was analyzed. The imaging result of the FO during surgery in the real puncture group was observed.

Among the 90 patients in the virtual imaging group, 75 had Class Ⅰ visualization of FO, 8 had Class Ⅱ visualization, and 7 had Class Ⅲ visualization. Compared with CT images, the sensitivity of Class Ⅰ visualization of FO under simulated X-ray was 97.4%, and the specificity was 100%. The consistency test showed good consistency (Kappa=0.92, P<0.001). During the percutaneous FO puncture in 12 patients, the FO were fully visualized and the FO puncture was successfully completed in all cases.

With the inclination angle determined through the specific projection of lower facial anatomical landmarks, the C-arm X-ray FO imaging method enables most patients to obtain good FO imaging results and can assist FO imaging during FO puncture.

To evaluate the application value of triggered electromyography (tEMG) in the assessment of neurological function during spinal cord tethering release surgery in children.

A retrospective analysis was conducted on the clinical data of 85 children with spinal cord tethering syndrome who were admitted to the Department of Neurosurgery, Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University from January 2020 to August 2022 and underwent intraoperative tEMG monitoring. A total of 48 children had neurological dysfunction preoperatively. All 85 patients were subjected to spinal cord tethering release surgery. The stimulation threshold and amplitude of the tEMG eliciting compound muscle action potential (CMAP) in the target muscle, which induced by nerve roots at the lesion site before surgery was documented. The nerve root was tested again immediately after surgery and the difference in tEMG thresholds before surgery and immediately after surgery was analyzed. The preoperative tEMG threshold was used to stimulate the nerve roots immediately after surgery, the difference in CMAP amplitude before and immediately after surgery was analyzed(the tEMG threshold and CMAP amplitude of each patient were the average values obtained when stimulating bilateral nerve roots at the lesion site), and improvement of neurological function in children after surgery was evaluated.

The surgeries were successfully completed in all 85 children. Postoperative pathology confirmed 43 cases of spinal lipoma, 8 cases of lipomyomeningocele, 6 cases of myelomeningocele, and 28 cases of secondary tethered cord syndrome. There were no postoperative complications such as cerebrospinal fluid leakage and incision infection. Neurological dysfunction improved in 70.8%(34/48) of the children after surgery. Compared with preoperatively, the tEMG threshold [M(Q₁, Q₃)] of the nerve root in the lesion site of the child decreased significantly immediately after surgery, and the difference was statistically significant [preoperative: 3.40 (1.60, 5.00)mA, immediately after surgery: 2.10 (1.50, 3.50)mA, Z=5.89, P<0.001)]. In 31 cases of spinal lipoma, 8 cases of lipomyelomeningocele, 5 cases of myelomeningocele and 17 cases of secondary tethered cord syndrome, the tEMG thresholds in the immediate postoperative period were significantly lower than those before surgery, and the differences were statistically significant (all P<0.05). With the tEMG threshold before tethered cord release surgery was being used to stimulate the nerve roots immediately after surgery, the CMAP amplitude[M(Q₁, Q₃)] of the nerve roots elicited immediately after surgery increased significantly compared with before surgery, and the difference was statistically significant [preoperative: 8.40 (5.00, 17.50)μV, immediately after surgery: 17.50 (8.15, 26.78)μV, Z=-6.20, P<0.001]. Among them, the CMAP amplitude of 36 children with spinal lipoma, 6 children with myelomeningocele, and 18 children with secondary tethered cord syndrome increased significantly immediately after surgery compared with that before surgery, and the differences were all statistically significant (all P<0.05), while the amplitude of CMAP did not change significantly before and immediately after surgery in 8 children with lipomyelomeningocele(P=0.192).

Intraoperative tEMG can not only help monitor and protect the neurological function of children, but also indicate the improvement of neurological function. It has good application value.

To comparatively evaluate the safety and feasibility of endovascular treatment of intracranial aneurysms using transradial approach (TRA) and transfemoral approach (TFA).

A retrospective analysis was performed on the clinical data of patients with intracranial aneurysms who underwent endovascular treatment at the Department of Neurosurgery, Qilu Hospital of Shandong University from March to August 2022. There were a total of 118 cases, of which 51 cases received TRA and 67 cases received TFA. There were no statistically significant differences in age, gender, history of related diseases, or aneurysm characteristics between the two groups of patients (all P>0.05). We then compared the puncture success time, working approach angle, guiding catheter placement time, operation time, immediate embolization effect, patient comfort score during operation, and perioperative complications (pseudoaneurysm at the puncture point, intraoperative thrombosis, stent thrombosis, symptomatic cerebral infarction) between the two groups of patients.

The operations were successful for both groups of patients, and no change of surgical approach occurred. The working approach angles [M(Q₁, Q₃)] of the TRA group and TFA were 45° (33°, 62°) and 59° (50°, 68°) respectively, the guiding catheter placement time [M(Q₁, Q₃)] were 12 (8, 20) min, 9 (7, 10) min respectively, the patient comfort scores [M(Q₁, Q₃)] were 93 (89, 98) points and 73 (68, 76) points respectively, and the differences were statistically significant (all P<0.05). The differences in puncture time, embolization effect or incidence of perioperative complications were not statistically significant (all P>0.05).

Compared with TFA, endovascular treatment of intracranial aneurysms with TRA is safe, feasible and more advantageous in patient comfort.

To explore the application value of high-resolution C-arm CT technology in the evaluation of stent opening and wall apposition during the placement of blood flow diverters (FD) in the carotid arteries of Bama miniature pigs.

Tubridge FD was inserted into the carotid artery of Bama miniature pigs using endovascular treatment. A high-resolution C-arm CT scan was performed immediately after the operation to evaluate the expansion degree of the FD and the quality of the post-processed images. Then a three-dimensional digital subtraction angiography (3D-DSA) scan of the FD-inserted blood vessel was performed. The post-processing workstation was used to have high-resolution C-arm CT and 3D-DSA image reconstructed using dual-volume fusion technology to obtain the fused image (referred to as the dual-volume reconstruction method), and diluted contrast agent was continuously injected while performing the high-resolution C-arm CT scan. The stent vascular reconstruction images obtained later (referred to as the diluted contrast medium method) were compared, and the radiation exposure doses of the two operating methods were documented to evaluate their accuracy and safety in FD apposition assessment. The occurrence of adverse events during surgery and within 24 hours after FD implantation was observed.

A total of 9 Tubridge FDs were placed in the left carotid arteries of 9 Bama miniature pigs. High-resolution C-arm CT plain scan reconstructed images showed that 8 FDs had full expansion and 1 case of underexpansion of the distal end of the FD. The image quality was grade Ⅰ in 8 cases and grade Ⅱ in 1 case. In terms of stent apposition, both the double-volume reconstruction method and the diluted contrast agent method could clearly demonstrate the apposition of FDs. Among them, 8 FDs showed good apposition (apposition score: 0 points), and 1 FD showed poor apposition at the distal end (apposition score: 1 point, classified as type Ⅰa). The consistency rate of the two assessment results was 100%. In terms of radiation exposure dose, the dual-volume reconstruction method was significantly higher than the diluted contrast agent method (906.89±44.49 μGym²vs. 725.44±42.17 μGym², t=24.36, P<0.001). Two experimental pigs suffered from moderate vasospasm during the application of diluted contrast media. No complications such as vascular dissection or thrombus detachment were observed in all animals during the operation and within 24 hours after operation.

High-resolution C-arm CT can clearly display the fine structure and full expansion of the domestic intracranial blood flow diverters, and combined with a variety of post-processing techniques, its wall apposition can be effectively observed.

At present, there is no standard treatment plan for recurrent and refractory pleomorphic xanthoastrocytoma and childhood high-grade glioma, and the effect of radiotherapy and chemotherapy is not good. The use of BRAF inhibitors and/or their downstream MEK inhibitors can inhibit the growth of BRAF V600E mutated tumors and improve the objective response rate of tumors. In June 2019 and May 2022, the Department of Neurosurgery, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, treated one patient with pleomorphic xanthoastrocytoma [World Health Organization (WHO) Grade 2] and one patient with childhood diffuse high-grade glioma (WHO Grade 4), both with BRAF V600E mutation and tumor progression after tumor resection, and targeted therapy with BRAF-MEK-MAPK signaling pathway inhibitor. By the last follow-up, the tumor was shrunk or stable.

Vestibular schwannoma (VS) is a common benign intracranial tumor originating from Schwann cells. The tumor itself and the neurological injury caused by surgery, mainly facial and auditory nerves, seriously affect the quality of life of patients. It is difficult to accurately distinguish and protect the auditory nerve during surgery, so intraoperative auditory electrophysiological monitoring is particularly critical. This paper summarizes the characteristics and related research progress of commonly used auditory monitoring schemes in clinic in recent years, in order to provide ideas for auditory protection of patients with VS.

Neurofibromatosis can be divided into type 1 neurofibromatosis, type 2 neurofibromatosis, and schwannomatosis according to the location and clinical manifestation of the gene mutation. For patients with type 1 neurofibromatosis, metabolic imaging combined with positron emission tomography (PET) and high-resolution anatomical localization function of CT or MRI can help to clarify the nature of tumors and achieve early diagnosis and intervention. For patients with type 2 neurofibromatosis, PET can be used to identify rapidly growing vestibular schwannomas and help screen potential therapeutic targets. For patients with schwannomatosis, there are few reports on the application of PET/CT and PET/MRI in the diagnosis of this disease. This article reviews the application of PET/CT and PET/MRI in the diagnosis of neurofibromatosis, in order to provide reference for the diagnosis and treatment of neurofibromatosis.

In recent years, advances in transcranial neuroendoscopy have changed the visualization and navigation capabilities of the ventricular system and expanded the field of neurosurgical treatment, which has been widely used in the surgical treatment of hydrocephalus. Ventriculo-peritoneal shunt (VPS) is a conventional treatment for hydrocephalus, but conventional VPS has a high recurrence rate and often requires revision or reoperation. Since the first successful completion of the third ventriculostomy for the treatment of hydrocephalus using neuroendoscopic technique 80 years ago, neuroendoscopic technique has gradually developed into the first-line treatment of hydrocephalus. Neuroendoscope-assisted catheterization under direct vision can significantly improve the accuracy of VPS, reduce the incidence of postoperative complications and the recurrence rate of hydrocephalus; Cyst fenestration assisted by neuroendoscopy plays an important role in the treatment of complex polycystic hydrocephalus with VPS; At the same time, neuroendoscopic technology can provide a new and effective solution for revision surgery after VPS failure. Therefore, transcranial neuroendoscopic technique for the treatment of hydrocephalus has become a good alternative minimally invasive treatment.

Microglia are the natural immune cells of the central nervous system and are the main mediators of neuroinflammation. After the occurrence of central nervous system diseases, excessive and persistent microglia inflammatory response can increase the permeability of blood-brain barrier, accelerate the occurrence of cerebral edema, and induce nerve cell apoptosis. Exosomes are extracellular vesicles with a diameter of 40 to 160 nm, which are non-immunogenic and can pass through the blood-brain barrier. At present, many studies have found that exosomes show significant anti-inflammatory effects in the treatment of various nervous system diseases by regulating the activity and function of microglia, and provide a new method for the treatment of central nervous system diseases. Therefore, this article reviews the research progress of exosomes in regulating microglia-related inflammation in central nervous system diseases, in order to provide new evidence for subsequent neuroinflammation treatment.