Volume 40 · Issue 04 · 2024

The journal Neuro-Oncology published online in June 2021 the Guidelines for the Diagnosis and Treatment of Meningiomas of the European Society of Neuro-Oncology, co-authored by 17 scholars from Germany, Switzerland and other countries. This guideline aims to provide a higher level of evidence support for the diagnosis and management of patients with meningioma. Due to the complexity of meningioma disease and ethnic and cultural differences between the East and the West, some of the recommendations in this guideline are not fully applicable to domestic patients. Therefore, this article combines the relevant literature to interpret this guideline, and at the same time summarizes and analyzes the focal issues of meningioma.

To compare the efficacy of postoperative remote programming and conventional outpatient programming of deep brain stimulation (DBS) for Parkinson′s disease (PD), and to explore the guiding role of microelectrode recording (MER) in selecting contacts for postoperative programming.

This study was a retrospective cohort study. A total of 122 PD patients who underwent bilateral subthalamic nucleus (STN)-DBS treatment at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from February 2019 to December 2021 were enrolled. The DBS devices was turned on at 1 month after surgery and follow-up was performed at 1 year after the start-up of device. According to the postoperative programming method and the selection strategy of stimulation contact in initial programming, the patients were divided into outpatient conventional programming group (39 cases), remote conventional programming group (41 cases) and MER-guided remote programming group (42 cases). The surgical outcomes of the three groups of patients were compared. Pre-baseline data, improvement rate of the sum of tremor and bradykinesia scores in the Unified PD Rating Scale Part Ⅲ(UPDRS-Ⅲ) during the 1-year med-off period after surgery, daily levodopa equivalent dose (LEDD) reduction rate, times of programming adjustments during the 1 year after start-up, the percentage of patients requiring programming adjustment at follow-up, the time taken in initial programming after device start-up, and the number of discomforts experienced during the start-up period.

There were no significant differences in age, gender, course of disease, Hoehn-Yahr stage, preoperative LEDD, preoperative "med-off" UPDRS-Ⅲ score, sum scores of preoperative "med-off" UPDRS-Ⅲ tremor and bradykinesia, or improvement rates of preoperative levodopa challenge test (LCT) among the three groups (all P>0.05). At the follow-up of 1 year after stimulation, there was no significant difference in the improvement rate of the sum scores of "med-off" UPDRS-Ⅲ tremor and bradykinesia in the three groups, while the reduction rates of LEDD [median (Q₁, Q₃)] in the remote conventional programming group [46.7% (30%, 50%)] and MER-guided remote programming group [46.6% (30%, 60%)] were both significantly higher than that in the outpatient conventional programming group [33.3% (0%, 50%), H=6.05, P=0.049]. The times of programming adjustments in the remote conventional programming group and MER-guided remote programming group was more than that in the outpatient conventional programming group [M(Q₁, Q₃): 5 (4, 7), 6 (5, 7) and 6(5, 8) respectively, H=8.35, P=0.015], while the patients′ programming requirements during follow-up were significantly less than those in the outpatient conventional programming group [percentage: 31.7% (13/41), 31.0% (13/42) and 56.4% (22/39) respectively, χ²=7.00, P=0.030]. The initial programming time of MER-guided remote programming group was significantly shorter than that of the outpatient conventional programming group and remote conventional programming group [M(Q₁, Q₃): 43.5 (36.0, 54.0) min, 125.0 (106.0, 134.0) min and 124.0 (104.5, 150.0) min respectively, H=79.72, P<0.001]. The number of discomforts was significantly less than that of the outpatient conventional programming group and remote conventional programming group [M(Q₁, Q₃): 1 (0, 1), 3 (3, 3) and 3 (3, 3) respectively, H=86.17, P<0.001].

Postoperative remote programming for PD patients can achieve therapeutic efficacy comparable to that of outpatient programming. The MER results can be used to guide the selection of programming contacts and improve the efficiency of remote programming with fewer adverse events, which is worthy of clinical promotion and application.

To explore the effect of deep brain stimulation of bilateral subthalamic nucleus (STN-DBS) on the mood and cognition in patients with Parkinson′s disease (PD).

The clinical data of 80 PD patients who underwent bilateral STN-DBS treatment at the Functional Neurosurgery of Affiliated Brain Hospital of Nanjing Medical University from April 2014 to December 2016 were retrospectively analyzed 5 years after surgery. Before surgery, 6 months after surgery, and 1, 2, 3, 4, and 5 years later, the patients were assessed based on the Unified Parkinson′s Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ), the 39-item PD Quality of Life Questionnaire in the off state (PDQ-39), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA); the L-dopa equivalent daily dose (LED) was calculated. We compared the changes in scores of patients and the LEDD before and after surgery, and analyze the correlation between the improvement of motor symptoms (UPDRS-Ⅲ score), quality of life (PDQ-39 score) and the improvement rate of MMSE, MoCA, HAMA, and HAMD scores.

Compared with those before surgery, the patient′s UPDRS-Ⅲ score (off period), LEDD, PDQ-39 score, HAMA score, and HAMD score at 6 months, 1, 2, 3, 4, and 5 years after surgery were all significantly reduced, the MoCA scores were all higher than those before surgery, and the differences were statistically significant (all P<0.05). The MMSE scores at 6 months, 1, 2, 3, and 4 years after surgery were higher than those before surgery, and the differences were statistically significant (all P<0.05), while the MMSE scores at 5 years after surgery were not different from those before surgery (P>0.05). Spearman rank correlation analysis results showed that there was a positive correlation between the patient′s MMSE score improvement rate at 1, 3, and 5 years after surgery and the PDQ-39 score improvement rate at the same time points (1 year after surgery: r_s =0.26, P= 0.026; 3 years after surgery: r_s=0.23, P=0.043; 5 years after surgery: r_s=0.35, P=0.002). There was a positive correlation (r_s=0.28, P=0.014) between the MoCA score improvement rate 5 years after surgery and the PDQ-39 score improvement rate corresponding to the same time point. There was no significant correlation between the patient′s MMSE, MoCA, HAMA, and HAMD score improvement rates at 1, 3, and 5 years after surgery and the UPDRS-Ⅲ score improvement rate at the corresponding time points (all P>0.05).

Bilateral STN-DBS is long-term effective in improving anxiety, depression and overall cognitive function in PD patients. The improvement in overall cognitive function in PD patients is related to the improvement in quality of life.

To compare and analyze the differences in efficacy, stimulation parameters and adverse reactions between caudal zone incerta (cZI) and subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of patients with tremor-dominant Parkinson′s disease (PD).

A total of 26 tremor-dominant PD patients who were treated with DBS at the Department of Neurosurgery, Zhongnan Hospital of Wuhan University from September 2018 to November 2021 were included for retrospective analysis. Among them, 10 cases (19 sides) used cZI as the stimulation target (cZI-DBS group), and 16 cases (30 sides) used STN as the stimulation target (STN-DBS). We evaluated the improvement rate of the Unified Parkinson′s Disease Rating Scale Part Ⅲ (UPDRS-Ⅲ) scores and its sub-scores (including tremor, rigidity, gait disorder and bradykinesia scores) as well as the reduction rate of levodopa equivalent daily dose (LEDD), stimulation parameters and stimulation-related adverse reactions after surgery compared with preoperative conditions in the two groups.

At 1, 3, 9, and 12 months after surgery, compared with the time before the DBS device was turned on, the average or median improvement rate of UPDRS-Ⅲ, tremor, rigidity, gait disorder, and bradykinesia scores of the two groups of patients after the device was turned on was ≥50%. Comparing the two groups, there was no statistically significant difference in the improvement rates of rigidity, bradykinesia, or gait scores at each time point after surgery (all P>0.05). In the cZI-DBS group, the improvement rates of tremor scores at 1, 3, 6, and 12 months were (92.15±6.36)%, (90.20±6.37)%, (85.38±9.72)%, and (89.62±7.18)% respectively; in the STN-DBS group, the improvement rates of tremor scores at 1, 3, 6 and 12 months were (63.22±17.17)% and (63.38±12.55)%, (61.91±13.17)%, (68.29±16.23)% respectively. The differences between the two groups at each time point were statistically significant (all P<0.05). There was no statistically significant difference in the rate of less LEDD between the two groups (P=0.576). the stimulation frequency, pulse width, electrode impedance, and stimulation power of the cZI-DBS group were lower than those of the STN-DBS group (all P<0.05). The incidences of adverse reactions related to stimulation were 3/10 in the cZI-DBS group and 11/16 in the STN-DBS group. There was a lower trend in the incidence of adverse reactions related to stimulation in the cZI-DBS group (P=0.063).

Both cZI and STN are effective targets for DBS in the treatment of tremor-dominant PD, while cZI-DBS controls tremor symptoms better than STN-DBS.

To investigate the efficacy and safety of deep brain stimulation of lateral habenula nucleus(LHb-DBS) for the treatment of refractory depression.

A prospective study was conducted on 6 patients with refractory depression who underwent deep brain stimulation of LHb-DBS in the Department of Neurosurgery of the First Medical Center of PLA General Hospital from March 2021 to April 2022. The Hamilton Depression Rating Scale (HDRS)-17, Hamilton Anxiety scale (HAMA), Montgomery-Åsberg Depression Rating Scale (MADRS), Pittsburgh Sleep Quality Index (PSQI), Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and Global Assessment Function (GAF) were used for assessment 1 month before surgery and 1, 3, 6, 9, 12, and 15 months after surgery respectively. Complications related to surgery and stimulation were also documented.

All 6 patients successfully underwent surgery. Five patients were followed up to 15 months after start-up of the DBS device, and one case was followed up to 1 month after start-up. At 1 month post start-up, the HDRS-17 score (average improvement rate: 60.3%), HAMA score (average improvement rate: 59.6%), MADRS score (average improvement rate: 61.1%) and QIDS-SR score (average improvement rate: 55.2%) were all decreased compared with the preoperative baseline, while the GAF score (average improvement rate: 46.9%) was increased. In the follow-up of 3-15 months after start-up, compared with the preoperative baseline, the average improvement rate of depression-related scale HDRS-17, MADRS and QIDS-SR scores in 5 patients was 60.3%-67.6%, 64.7%-79.4% and 47.4%-63.2%. For anxiety, the average improvement rate of HAMA score ranged from 57.7% to 71.6%. In terms of sleep, the average improvement rate of PSQI score was 17.2%-31.7%. The GAF score was increased by 47.6%-87.6%. During the perioperative period and follow-up period, there were no cases of surgery-related complications such as intraoperative hemorrhage, ischemia, or wound infection, and no device-related adverse events were observed. During the treatment period, stimulus-related adverse events were recorded in 4 patients, which were relieved after adjusting the stimulus contacts and stimulation parameters.

The treatment of patients with refractory depression with LHb-DBS can improve depression, anxiety and quality of life. No serious complications related to surgery or stimulation have been observed.

To explore the surgical efficacy and prognostic factors in temporal lobe epilepsy (TLE) patients with hippocampal sclerosis combined with temporal lobe neocortical lesions.

The clinical data of 62 TLE patients who underwent anterior temporal lobe resection for hippocampal sclerosis combined with temporal lobe neocortical lesions at the Department of Neurosurgery, Xiangya Hospital, Central South University from January 2014 to April 2018 were retrospectively collected. Patients were followed up 3 months after surgery and every year by outpatient or telephone interviews. The surgical efficacy was graded according to the International League Against Epilepsy (ILAE) epilepsy surgery outcome standards and divided into a favored outcome group (favored group) and an unfavored outcome group (unfavored group). Univariate and multivariate logistic regression analyses were used to evaluate factors that may affect the surgical efficacy. Variables with P<0.05 in the univariate analysis were included in multivariate analysis to determine the risk factors for unfavored postoperative outcome. According to the postoperative pathology type, the patients were divided into focal cortical dysplasia (FCD) Ⅲa (hippocampal sclerosis combined with temporal lobe neocortex FCD type Ⅰ) group and dual pathology (hippocampal sclerosis combined with other pathological lesions) group. The differences in clinical characteristics and surgical efficacy of patients with different pathology types were analyzed.

Postoperative pathology confirmed that 43 patients (69.35%) had FCD type Ⅲa; 19 patients (30.65%) had dual pathology. The operations of 62 patients were successfully completed, and 6 patients (9.68%) experienced postoperative complications, including 1 case of intracranial hemorrhage, 1 case of subarachnoid hemorrhage, 1 case of intracranial infection, 1 case of mild hemiplegia, 1 case of mania, and 1 case of persistent mild aphasia. At 3 months post surgery, 50 patients (80.65%) had no seizures or had aura of epilepsy; 12 patients (19.35%) still had epileptic seizures after surgery. All 62 patients received clinical follow-up, and the follow-up time was 3.37±0.94 years. By the last follow-up, 49 patients (79.00%) had no epileptic seizures after surgery, including 46 patients with ILAE grade 1 outcome and 3 patients with grade 2 outcome; 13 patients still had epileptic seizures after surgery, including 3 cases of ILAE grade 3, 6 cases of grade 4, 3 cases of grade 5, and 1 case of grade 6. The results of univariate analysis showed that the differences in age at surgery, side of the lesion, and interictal epileptiform discharges (IEDs) between the postoperative favored outcome group and unfavored outcome group were statistically significant (all P<0.05); while there were no statistically significant differences in gender, disease course or age of onset (all P>0.05). Multivariate analysis results showed that existence of bilateral IEDs was a risk factor for unfavored postoperative outcome (OR=8.57, 95%CI: 1.62-45.40, P=0.012). Compared with the dual pathology group, the patients in the FCD Ⅲa group were older at surgery and had a longer course of disease, and the differences were statistically significant (both P<0.05). However, there was no statistically significant difference in the postoperative efficacy between the two groups (P>0.05).

Surgical resection is an effective way to treat TLE patients with hippocampal sclerosis and temporal lobe neocortex lesions. Existence of bilateral IEDs is a risk factor for poor surgical efficacy. Although there are differences in clinical characteristics between patients with FCD type Ⅲa and dual pathology, the surgical outcomes are similar between the two groups.

To investigate the effect of aperiodic components on the results of local field potential (LFP) analysis of the subthalamic nucleus (STN) in patients with Parkinson′s disease (PD) and its physiological significance in the assessment of motor symptoms.

A total of 27 PD patients with bilateral STN deep brain stimulation admitted to the Department of Functional Neurosurgery, Center for Neurosurgery, Zhujiang Hospital, Southern Medical University from February 2019 to September 2021 were retrospectively analyzed, of whom 21 were implanted with a classical pulse generator, and 6 were implanted with a novel pulse generator. Intraoperative and postoperative (only 6 patients implanted with the novel pulse generator) STN-LFP were collected from 1 to 6 months. Preoperative and postoperative limb motor symptoms were assessed using the third part of the Unified Parkinson′s Disease Rating Scale, which included symptom scores for tremor, rigidity, and bradykinesia, as well as the sum of the three motor symptom scores. The neuronal power spectrum parameterization method was used to obtain the power values of the β-band of the original, fitted, original flat, and fitted flat spectra of the four spectra of the STN-LFP and the extracted aperiodic components (the aperiodic components, with the last two spectra obtained by removing the aperiodic components from the first two spectra, respectively), and to analyze the correlation between the aperiodic components and the motor symptoms. The patients with PD were classified into 2 motor subtypes: akinetic type (12 cases) and tremor-dominant type (15 cases). The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to analyze the efficiency of the four spectrum identification of PD motor subtypes. The correlation between electrophysiological characteristics of different frequency bands of the 4 spectra and the motor symptoms was also analyzed.

No correlation was found between the aperiodic component of intraoperative LFP and the preoperative limb motor symptom scores in 27 patients (all P>0.05). Six patients implanted with the new pulse generator had a postoperative follow-up [M(IQR)] of 2.00 (2.75) months, and none of the aperiodic components of postoperative LFP correlated with the postoperative limb motor symptom scores (all P>0.05). ROC plot results showed that that the AUCs of the 4 spectra in the above order were 0.69, 0.67, 0.84 and 0.89, respectively. The classification efficacy of the fitted flat spectrum was better than that of the fitted spectrum (Z=1.86, P=0.033) and the original spectrum (Z=1.67, P=0.041), and the difference was statistically significant. The frequency-by-frequency power values of the four spectra of intraoperative and postoperative LFP were correlated with motor symptom scores in different frequency bands (all P<0.05).

Despite no correlation between the aperiodic component itself and motor symptoms, it affects the results of STN-LFP spectral analysis and the classification efficacy of LFP-based determination of motor subtypes in patients with PD.

To analyze the clinical characteristics of patients with primary drug-refractory glossopharyngeal neuralgia (GPN) and the efficacy of different surgical methods.

A total of 61 patients with drug-refractory GPN diagnosed and treated at the Neurosurgery Department of Tianjin Huanhu Hospital from March 2014 to March 2021 were included for retrospective analysis. The male/female ratio was 32/29; the age was (67.7±25.4) years old (43-88 years old); the median disease duration was 44.1 months (7 days to 18 years). Microvascular decompression (MVD) was performed in 39 cases; rhizotomy (RHZ) was performed in 22 cases to cut off the glossopharyngeal nerve and the first branch of the vagus nerve. We documented the offending blood vessels of GPN, surgical efficacy and related complications.

Among the 61 patients, most patients (63.9%, n=39) had the posterior inferior cerebellar artery (PICA) as the offending blood vessel identified during surgery, and 2 patients (3.3%) had no vascular compression. The pain of both groups of patients disappeared immediately after surgery, and the effective rate was 100%. After surgery, 2 patients in the MVD group developed cerebral hemorrhage, 1 died, and 1 remained with symptoms of mild neurological deficit. Eight cases (36.4%) in the RHZ group had dysfunction related to cranial nerves Ⅸ, Ⅹ and Ⅺ, of which 5 cases were uvula deviation and 3 cases were coughing during swallowing; 1 patient in MVD group (2.7%) had coughing during swallowing; the difference between the two groups was statistically significant (P=0.001). All 61 patients were followed up for (56.7±38.5) months (12 to 96 months) after surgery, and 1 patient (2.7%) in the MVD group had recurrence of pain 46 months after surgery. The 5 patients with uvula deviation all improved 6 months after surgery; among the 4 patients with choking and coughing when swallowing, only 1 patient in the RHZ group occasionally had symptoms of choking and coughing.

MVD is an effective surgical procedure for the treatment of primary GPH. RHZ is an effective complementary procedure to MVD. Although the incidence of complications is high, most of them can be recovered without serious complications.

To preliminarily analyze the multi-scale characteristics of neuromuscular functional coupling (FCMC) in stroke patients and to investigate its role in motor function assessment.

We selected healthy individuals (n=8, healthy control group) and post-stroke patients (n=8, stroke group) with right upper limb hemiplegia who were hospitalized in the Department of Neurosurgery of the First Medical Centre of People′s Liberation Army (PLA) General Hospital from January 2018 to March 2018 as the research subjects. The patients were subjected to a right upper limb constant grip strength test, and the synchronously acquired multichannel electroencephalography and electromyography signals were analyzed by complex multiscale coherence (CMSC) analysis. Significant area metrics were calculated at 20-time scales using the consistency significance threshold calculation method. Differences in significant area metrics between the stroke group and healthy control group were compared using a two-way repeated measures analysis of variance (ANOVA). Pearson′s correlation analysis was used to verify the correlation between the multiscale FCMC significant area metrics and the Ueda min grade of the right upper limb in patients in the stroke group.

In comparison with the healthy control group, the stroke group exhibited predominantly lower CMSC values across different scales and frequency ranges, and high CMSC values were mostly found in the high-frequency band (45-60 Hz). Among the healthy control group, 6 out of 8 subjects had higher CMSC values around scale 10 in the low-frequency range (<1 Hz), whereas 5 out of 8 patients in the stroke group had lower CMSC values. Two-factor repeated-measures analysis of variance showed statistically significant differences in significant areas between the stroke group and healthy controls (F_{between groups}=14.20, P_{between groups}=0.007; F_{time scale}=14.35, P_{time scale}<0.001; F_interaction=13.29, P_interaction<0.001). Significant areas on scales 9, 10, 11, and 12 were lower in the stroke group compared with healthy controls (all P<0.05). Pearson′s correlation analysis showed that significant area metrics in the stroke group were positively correlated with the Ueda Min scale grade at scales 9 (r=0.74, P=0.032), 10 (r=0.62, P=0.021), and 12 (r=0.71, P=0.030), respectively.

Preliminary analyses indicate that the multi-scale FCMC phenomenon exists after stroke, and the scale characteristics are altered compared with those of healthy individuals. The scale-specific FCMC characteristic indicators can be used to clinically assess the motor status of stroke patients.

To build a pre-trained deep learning neural network model based on MRI T1 weighted enhanced sequence; to evaluate the diagnostic performance of identifying the primary central nervous system lymphoma (PCNSL), glioblastoma (GBM) and brain metastase (BM).

A retrospective analysis were conducted on the patients who underwent surgical treatment and were diagnosed with PCNSL, GBM, and BM by postoperative pathological examination from January 2015 to June 2022 at the Neurosurgery Department of the First Affiliated Hospital of China Medical University. A total of 149 cases were enrolled according to the inclusion standard, including 43 PCNSL, 62 GBM, and 44 BM. Those were randomly divided into a training set and a test set. After obtaining imaging data, the Slicer software was used for delineating regions of interest and pre-processing was conducted. A deep learning neural network model based on EfficientNetV2 with pre-trained and fine-tuned on ImageNet datasets was constructed, and then trained on the training set by transfer learning. The model was validated on the testing set, and then the classification performance metrics was evaluated by receiver operating characteristic(ROC) curves, accuracy, recall (sensitivity), precision, specificity, F1 score, and area under the ROC curve (AUC).

The overall accuracy of the model was 89.4% and the average AUC was 0.96. The sensitivity of the model for PCNSL, GBM, BM were 0.893, 0.936, and 0.778 respectively. The specificity were 0.996, 0.877, and 0.955 respectively. The F1 score were 0.940, 0.900, and 0.778 respectively. The AUC(95%CI) were 0.98(0.946-0.997), 0.96(0.932-0.986) and 0.95(0.905-0.980) respectively.

The pre-trained deep learning neural network model trained on T1-weighted enhanced MRI scans has an outstanding diagnostic performance for PCNSL, GBM and BM.

To observe the effect of Syphonet stent on distal protection in recanalization of chronic intracranial and extracranial long-segmental artery occlusion (CIEAO).

The clinical data of 9 patients with CIEAO who underwent recanalization at the Department of Cerebrovascular Disease, Henan Provincial People′s Hospital from November 2022 to April 2023 were retrospectively analyzed. The Syphonet stent was used as the distal protection device during the operation in all patients. Successful recanalization of vessels was defined as modified thrombolysis in cerebral infarction (mTICI) ≥2b. The surgical procedure and surgery-related complications were documented. Cranial imaging examination was performed at 6 months after the operation to evaluate vascular recanalization; the modified Rankin Scale (mRS) was used to evaluate the outcomes of patients.

All 9 patients achieved successful recanalization. The median number of stents placed was 2 (1-4), all stents adhered to the vascular wall well, and the operation time was 176 (120-220) minutes. During the perioperative period, 1 patient had intraoperative thrombus escape, which entered the Syphonet distal protection device and was successfully retrieved. At 6 hours post operation, 1 patient had cerebral hemorrhage (possibly hemorrhagic transformation after subacute cerebral infarction), and there was no death cases. At 6-month follow-up after the procedure, 1 patient was lost to follow-up; imaging evaluation showed in-stent vessel reocclusion in 2 patients and no in-stent vessel stenosis in the remaining patient. The mRS score was 0 in 5 cases, 1 in 1 case, 2 in 1 case, and 3 in 1 case.

The application of Syphonet stent distal protection technique in recanalization of CIEAO has a high technical success rate, which can capture the escaped thrombus and reduces the complications caused by thrombus detachment. In-stent restenosis or occlusion needs further study.

To explore the clinical effect of microsurgery in the treatment of hemorrhagic intracranial arteriovenous malformation (AVM) in children.

The clinical data of 34 children with hemorrhagic intracranial AVM who underwent microsurgery at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2022 were retrospectively analyzed. The preoperative Spetzler-Martin score (SMG) was 1 in 4 cases, 2 in 11 cases, 3 in 13 cases, and 4 in 6 cases. All children underwent craniotomy for resection of cerebral vascular malformations and hematoma evacuation, and the appropriate surgical plan was selected according to the indications. A head CT examination was performed on the first day after the operation to evaluate whether there was intracranial hemorrhage and brain tissue swelling. A head MR examination was performed one week after the operation to evaluate whether there was any residual vascular malformation. The Glasgow coma scale (GCS) was used to evaluate the postoperative improvement of consciousness disorder of the children. Children were followed up in outpatient clinics or by telephone, and cranial MRI or whole-brain DSA was performed 3 and 6 months after surgery to evaluate whether there was residual or recurrence of vascular malformations. The modified Rankin scale score (mRS) was used to evaluate the recovery of neurological function in children and the mRS of 0-1 was considered as good outcome. According to the preoperative SMG grading, the patients were divided into SMG ≤ 3 group and SMG > 3 group, and the outcome difference between the two groups of surviving children was analyzed.

The operations of 34 children were successfully completed. Among them, 25 children underwent direct craniotomy to remove vascular malformations and hematomas; 6 children underwent hybrid surgeries; 3 children underwent partial embolization of cerebral vascular malformations and then surgical resection. Thirty-one cases (91.2%) of the children underwent total resection of intracranial AVM during the first operation; 3 cases (8.8%) underwent near-total or major resection, and 1 case underwent total resection of intracranial AVM during the second operation. Two children died after surgery (both had preoperative SMG points of 3); 3 cases developed severe disability (1 had preoperative SMG of 3 points, 2 had preoperative SMG of 4), including 2 cases of long-term coma and 1 case of hemiplegia. The GCS score at discharge was 3 to 8 in 2 cases, 9 to 12 in 2 cases, and 13 to 15 in 28 cases. All 32 surviving children received clinical follow-up, and the follow-up time was 35.2±10.1 months; as of the last follow-up, there was no residual or recurrence of vascular malformation, 26 cases had good outcome, and 6 cases had poor outcome. Compared with preoperative SMG > 3 group, the outcome of children in the preoperative SMG ≤ 3 group was significantly better (the proportions of good outcome were 2/6 and 23/26 respectively, P=0.012).

Microsurgery is the first choice treatment for hemorrhagic intracranial AVM in children, especially for children with SMG ≤3 points. A reasonable surgical plan should be adopted according to the patient′s indications. Preoperative vascular embolization and hybrid surgery can help to completely remove intracranial AVM.

To compare the clinical efficacy of transsylvian insular approach and transtemporal cortical approach in the treatment of basal ganglia hemorrhage.

The clinical data of 152 patients with basal ganglia hemorrhage who underwent craniotomy in Department of Emergeroy Stroke, the Affiliated Hospital of Jining Medical University from September 2018 to December 2022 were retrospectively analyzed. The patients were divided into transsylvian insular approach group (sylvian approach group, 74 cases) and transtemporal cortical approach group (cortical approach group, 78 cases) according to different surgical approaches. The operation time, The ratio of bone flap return, hematoma clearance rate, and postoperative rebleeding were compared between the two groups. Three months after operation, the language function of the two groups of patients with left cerebral hemorrhage was compared and analyzed. At 6 months after operation, the modified Rankin scale (mRS) score was used to evaluate the outcomes of the patients. The mRS ≤2 was defined as good outcome, and mRS > 2 was defined as poor outcome.

The ratio of bone flap return and hematoma clearance rate of the sylvian fissure approach group were 73.0% (54 cases) and (94.3±5.5)%, respectively, which were significantly different from those [50.0% (39 cases) and (86.9±14.1)%] of the cortical approach group (both P< 0.01). There were no significant differences in operation time or rebleeding rate between the two groups (both P>0.05). At 3-month follow-up, among 34 patients with left basal ganglia hemorrhage in sylvian approach group, the rates of dysarthria and aphasia were 35.3% (12 cases) and 5.9% (2 cases) respectively. Of the 36 patients in the cortical approach group, the rates of dysarthria and aphasia were 44.4% (16 cases) and 30.6% (11 cases) respectively, and the inter-group differences were statistically significant (P=0.004). At 6 months after operation, 21.6% (16/74) of the patients in the sylvian approach group had good outcome and 78.4% (58/74) had poor outcome. In the cortical approach group, 5.1% (4/78) of the patients had good outcome, 94.1% (74/78) of the patients had poor prognosis, and the difference between the two groups was statistically significant (P=0.003).

Compared with the transtemporal cortex approach, the transsylvian insular approach has less trauma, lower postoperative complications and relatively better outcome in the treatment of basal ganglia hemorrhage.

To investigate the application effect of pre-molded polyetheretherketone (PEEK) in the management of fibrous dysplasia in the fronto-orbito-nasal region.

The clinical data of 12 patients with fibrous dysplasia involving fronto-orbito-nasal region admitted to the Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University from January 2020 to January 2023 were retrospectively analyzed. All patients underwent surgical resection of the cranial bone lesions and repair of the skull defect with pre-molded PEEK. Three patients with optic nerve compression and vision loss were simultaneously treated with optic canal decompression, and the patients with sinus opening during operation were treated with sinus repair and reconstruction. All patients underwent postoperative orbital and cranial CT, and were followed up at 3, 6, and 12 months after surgery by outpatient clinic and telephone inquiries to assess the efficacy and safety of the treatment in terms of the degree of cosmetic recovery and the incidence of complications.

Surgeries were successfully completed in all 12 patients. Eight patients underwent open sinus reconstruction, and no cerebrospinal fluid leakage occurred after surgery. At the time of discharge, the patients′ preoperative symptoms of frontal bony deformity (12/12) and ocular protrusion (11/11) had disappeared. All patients had symmetrical bilateral brow arches with good cosmetic recovery. The follow-up time [M(Q₁, Q₃)] for 12 patients was 12 (6, 12) months. By the final follow-up, none of the cases had complications such as implant displacement or infection.

The application of pre-molded PEEK in repair of bone defects after lesion resection in patients with fibrous dysplasia in the fronto-orbito-nasal region can improve patients′ symptoms and restore their appearance with good efficacy and safety.

To investigate the effects of aurora kinase A (AURKA) inhibitor on the proliferation of glioblastoma (GBM) cells and expression of immune checkpoint B7-H3.

The Chinese Glioma Genome Atlas (CGGA) dataset (325 cases) was used to analyze the correlation between expression levels of AURKA mRNA and clinical data including histopathology, World Health Organization(WHO) grade, primary/recurrent status, overall survival (OS), O⁶-methylguanine-DNA-methyltransferase (MGMT) methylation, isocitrate dehydrogenase (IDH) mutation and chromosome 1p19q co-deletion. The expression levels of AURKA mRNA in different histopathology types, WHO grades, and primary/recurrent status gliomas were analyzed. We compared the OS of glioma patients with different expression levels of AURKA mRNA using Kaplan-Meier survival curves. The effects of AURKA mRNA expression level, IDH mutation, chromosome 1p19q co-deletion, age, radiotherapy, chemotherapy, WHO grade and primary/recurrent status on the OS of glioma patients were assessed through univariate and multivariate Cox regression analyses. Receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was used to evaluate the performance of AURKA mRNA expression level in predicting the OS of glioma patients. Tissue samples of gliomas were collected from patients undergoing surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University, including 4 low-grade gliomas (LGG) and 4 GBM tissue samples. The expression of AURKA in the tumor tissue samples was detected by Western blot (WB). The human GBM cell line U87-MG was treated with AURKA inhibitor alisertib and U87-MG cells were divided into a control group (treated with DMSO) and an alisertib-treated group (treated with 5 μmol/L alisertib). The effects of alisertib on GBM cells proliferation and colony formation were detected by cell counting Kit-8(CCK-8) test and crystal violet staining, respectively. The effects of alisertib on the expression of AURKA, phosphorylation Thr288 of AURKA and B7-H3 were detected by WB. Flow cytometry was applied to detect the expression of membrane protein B7-H3 in GBM cells.

In the CGGA dataset, the expression level of AURKA mRNA in GBM was significantly higher than that in astrocytoma and oligodendroglioma (both P<0.001). The expression level of AURKA mRNA increased with WHO grades (P<0.001). The expression level of AURKA mRNA was higher in recurrent gliomas than in primary gliomas (t=4.50, P<0.001). Kaplan-Meier survival curve analysis showed that patients in the high AURKA mRNA expression group had shorter survival than those in the low expression group (all P<0.05). The univariate Cox regression analysis showed that AURKA mRNA expression level, IDH mutation, chromosome 1p19q co-deletion, age, radiotherapy, chemotherapy, WHO grade and primary/recurrent status were all influential factors in the survival (all P<0.05). The multivariate Cox regression analysis showed that high expression level of AURKA mRNA, recurrent status, high WHO grade, age, chemotherapy and chromosome 1p19q co-deletion were independent risk factors (all P<0.05). ROC curve analysis showed that the AUC of AURKA mRNA expression level to predict 1-year, 3-year and 5-year survival glioma patients was 0.78 (95%CI: 0.72-0.83), 0.85 (95%CI: 0.80-0.89) and 0.84 (95%CI: 0.79-0.89) respectively. WB results based on clinical samples showed that the protein level of AURKA in GBM was significantly higher than in LGG (t=2.62, P=0.040). CCK-8 results indicated that alisertib significantly inhibited the activity of U87-MG cells after 24 h, 48 h and 72 h of treatment (all P<0.05). Similarly, colony formation experiment results showed that alisertib significantly inhibited the clone formation of U87-MG cells (t=9.30, P<0.001). WB results showed that the phosphorylation level of AURKA in alisertib-treated group was lower than in control group (t=10.98, P<0.001), while the expression level of B7-H3 protein was higher than in the control group (t=7.55, P=0.002). Flow cytometry showed that the alisertib-treated group had increased B7-H3 expression on the cell membrane compared to control group (t=20.04, P<0.001).

AURKA inhibitor alisertib can effectively inhibit GBM cells proliferation and increase the expression of immune checkpoint B7-H3.

Based on the standard Stupp regimen of concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide, the new Stupp regimen of concurrent tumor electric field therapy during chemotherapy has become the recommended treatment for glioblastoma (GBM). The concept of molecular GBM is proposed in the 5th edition of central nervous system tumor classification by the World Health Organization. Whether the clinical benefit of using the new Stupp protocol for patients with this subtype remains to be explored. The Department of Neurosurgery, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, treated a patient with molecular GBM in September 2019 and was treated with the new Stupp regimen. The local control of the postoperative area was good until the intracranial distant site progression occurred 26 months after the operation. This protocol improves the prognosis of patients with molecular GBM while improving the quality of life of patients without causing serious complications.

Dystonia is a kind of dyskinesia disease that seriously affects the quality of life of patients. For patients who are ineffective in drug treatment, deep brain stimulation (DBS) is the main treatment. The selection of therapeutic targets is broader in the medial globus pallidus (GPi); In recent years, there are more and more reports of targeting the subthalamic nucleus (STN). This paper reports a case of dystonia who was treated with bilateral STN-DBS and then treated with bilateral GPi-DBS. After the combined stimulation of two targets, the symptoms of the patient improved significantly and recovered well.

Due to the existence of blood-brain barrier, it is difficult for traditional drug molecules to enter the brain, which is the biggest obstacle to drug treatment of brain tumors. How to safely and effectively achieve targeted brain tumor drug delivery across the blood-brain barrier has always been a challenging research problem. With the gradual increase of research on nano-drug delivery technology in recent years, nano-drug delivery systems have shown great potential in crossing the blood-brain barrier and targeting brain tumors. Various nanocarriers can be designed with different sizes, shapes and surface functional group modification, thereby improving the ability to penetrate the blood-brain barrier and target drug delivery to brain tumors. In this paper, the transcellular transport pathway in the strategy of overcoming the blood brain barrier and some nanocarriers that can cross the blood brain barrier through this pathway are reviewed, and their mechanism of action on the blood brain barrier and the factors affecting the drug delivery effect are expounded.

Neurointerventional surgery is an important method to treat neurological diseases. Robot-assisted therapy can not only improve the accuracy of surgery, but also reduce risks such as radiation exposure. At present, the robots clinically used in neurointerventional surgery include CorPath GRX, Magellan, VIR, RobEnt, "Luban" and VAS HERO systems, and have successfully completed whole cerebral angiography, carotid artery stenting, aneurysm stent and blood flow guide device placement, coil embolization and arteriovenous fistula embolization, with high safety and effectiveness. In order to complete neurointerventional surgery more accurately and smoothly, on the basis of the previous pan-vascular interventional robot, control software adapted to intracranial blood vessels, guide wire delivery module, tactile feedback system, etc. are added in clinical application. However, neural interventional robots are still in a period of continuous improvement and iterative development. With the maturity of technology, they are expected to make rapid progress in movement ability, precise control, interactive feedback and biological simulation, and will provide patients with more accurate and safe clinical treatment in the future.

Intracranial aneurysms are tumor-like protrusions formed by pathological changes in the wall of intracranial arteries, and their prevalence is 3% ~7%. However, once an intracranial aneurysm ruptures, its disability and mortality rate are high, so it is crucial to identify unstable aneurysm in advance. For many years, the pathophysiological mechanisms of formation, growth and rupture of intracranial aneurysms have been the focus of many researches. This article reviews the molecular mechanisms, risk factors and the application progress of imaging and artificial intelligence in the evaluation of intracranial aneurysms, so as to provide help for the stability evaluation of intracranial aneurysms.