Volume 40 · Issue 07 · 2024

Intracranial aneurysms are common diseases, and most aneurysms are found before rupture. Because the management principles of unruptured intracranial aneurysms (UIAs) and ruptured aneurysms are different, the stability of UIAs needs to be evaluated once they are discovered. However, there are many factors affecting the stability of UIAs. At present, there is still a lack of unified and objective evaluation standards, and the current two international evaluation systems are not applicable to Chinese patients. Therefore, it is of great significance to establish risk assessment standards for UIAs. With the deepening of research and the development of big data and artificial intelligence technology, it is expected to establish a scientific, accurate and easy-to-operate UIAs risk assessment standard that meets the disease characteristics of China's population.

To explore the effect of using intracranial aneurysm auxiliary assessment software to evaluate the stability of unruptured aneurysms (UIA).

UIA patients who visited the Neurosurgery Department of 7 centers including Beijing Tiantan Hospital, Capital Medical University from May to September 2022 were prospectively included. Software-assisted physician assessment, physician independent assessment, the expert group assessment, PHASES score, and ELAPSS score were used to evaluate whether the aneurysms of all patients were stable. Stratified random sampling was used to randomly divide patients into two groups, A and B. Group A was first evaluated by software-assisted doctors, and then independently evaluated by doctors after a 4-week washout period; group B was evaluated in the opposite order. The evaluation results of the expert group were used as the " gold standard" to judge the stability of UIA, and the accuracy, sensitivity and specificity of the aneurysm auxiliary evaluation software and other evaluation methods were compared. The consistency of these methods with " gold standard" were also compared. Subgroup analysis was performed according to the maximum aneurysm diameter.

A total of 192 patients (227 aneurysms) were included, including 62 males and 130 females; age [M(Q₁, Q₃)] was 58.0 (50.5, 65.0) years old. Among the 227 aneurysms, 98 were stable and 129 were unstable. The accuracy and sensitivity of software-assisted physician assessment (92.5% and 93.8%) were higher than those of physician independent assessment (76.7% and 85.3%), PHASES score (62.6% and 39.5%) and ELAPSS score (79.3% and 76.7%), the differences were statistically significant (all P<0.05). The difference between the specificity of software-assisted physician assessment (90.8%) and PHASES score (92.9%) and ELAPSS score (82.7%) was not statistically significant (both P>0.05), but was higher than that of physician independent assessment (65.3%, P<0.05). In terms of consistency, compared with the " gold standard", there were no statistically significant differences in the results of software-assisted physician evaluation (Kappa=0.94), physician independent evaluation (Kappa=0.81) and ELAPSS score evaluation (Kappa=0.83) (all P>0.05), among which the software-assisted physician assessment had the best consistency with the " gold standard" ; and the difference between the PHASES score and the " gold standard" assessment results was statistically significant (paired χ²=45.84, P<0.001). Subgroup analysis results showed that in the maximum diameter <3 mm group, 3-5 mm group and >5-7 mm group, the software-assisted physician assessment had high consistency with the " gold standard" (Kappa was 0.94, 0.79 and 0.85 respectively) to other assessment methods. There was no statistical significance in the accuracy of software-assisted physician assessment and physician independent assessment between group A and group B (both P>0.05).

The intracranial aneurysm auxiliary assessment software can assist neurosurgeons in assessing the stability of UIA. Its accuracy is better than the assessment results of independent assessment by doctors, PHASES score and ELAPSS score, and it is worthy of clinical promotion and application.

To explore the safety and efficacy of flow diverter (FD) in the treatment of patients with intracranial ruptured aneurysm.

The clinical data of 28 patients with intracranial ruptured aneurysms (28 aneurysms in total) treated with FD at the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2021 were retrospectively analyzed. Among them, there were 8 males and 20 females; the age was 55.6±14.0 years old. Eighteen patients were treated with Pipeline embolization device (PED), and 10 patients were treated with Tubridge FD. Perioperative complications were recorded. All patients were hospitalized for digital subtraction angiography (DSA) examination 6 to 24 months after surgery, and the Kamran grade was used to evaluate the embolization of the aneurysm (Kamran grade 4 as complete embolization); the modified Rankin scale (mRS) to evaluate the patient′s outcome (mRS of 0 to 2 points as good outcome).

A total of 30 FD stents were used in 28 patients, of which 2 patients used 2 stents; 19 patients were treated with combined coils. Among the 28 patients, 6 (21.4%) experienced perioperative complications, of which 5 (17.8%) were hemorrhagic complications and 1 (3.6%) were ischemic complications; the mortality rate was 7.1% (2/28). Among the 28 patients, 25 were followed up, and the median follow-up time was 14 (6 to 24) months. As of the last follow-up, 1 case of aneurysm was Kamran grade 2, 2 cases were grade 3, and 22 cases were grade 4. The aneurysm complete occlusion rate was 88.0% (22/25); 21 cases had an mRS of 0 to 2, and 7 had an mRS of 3 to 6. For example, the good outcome rate was 75.0% (21/28).

As a method for the treatment of intracranial ruptured aneurysms, FD has a low perioperative complication rate and a high short- and medium-term aneurysm occlusion rate, and has good safety and effectiveness.

To investigate the efficacy of stent implantation scheme in single stent-assisted coiling (SSAC) for the treatment of intracranial wide-necked bifurcation aneurysms (WNBA).

This retrospective analysis was performed on clinical data of 39 patients with unruptured WNBA admitted to the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from April 2022 to May 2023. Twenty-two patients (SSAC group) were treated with SSAC based on the stent implantation scheme, of which side branches were selected to implant stents according to the principle of "distal side branch, large angular side branch, and large diameter side branch". Seventeen patients with WNBA who were treated with double stent-assisted coiling (DSAC) were enrolled in this study(defined as DSAC group). Patients in the two groups were compared on age, gender and the aneurysm location, aneurysm size, single aneurysm or multiple aneurysms, the number of daughter sac and Hunt-Hess scale (HHS) before operation as well as the ratio of in-stent thrombosis during the operation. The degree of aneurysm occlusion was evaluated based on the Raymond-Roy Occlusion Classification (RROC). The modified Rankin Scale (mRS) score was used to assess neurological function both at discharge and 3 to 6 months post operation. Furthermore, patients were reexamined on in-stent stenosis and RROC by imaging follow-up.

There was no statistically significant difference between two groups on age, gender, aneurysm size, single aneurysm or multiple aneurysms, the number of daughter sac, or HHS before operation (all P>0.05). The difference in aneurysm location between the two groups was statistically significant (P<0.05). There was no statistically significant difference between SSAC group and DSAC group on the proportion of complete occlusion of the aneurysm, which were respectively 21/22 vs. 17/17 immediately after operation and 12/15 vs. 14/14 during follow-up period (both P>0.05). However, patients in SSAC group had lower ratio in intraoperative stent thrombosis (3/22 vs. 10/17) and in-stent stenosis during follow-up period(1/15 vs. 7/14) than in DSAC group(both P<0.05). The median of mRS both after operation and during follow-up period in SSAC group were lower than those in DSAC group (both 0 vs. 2, both P<0.05).

The application of stent implantation scheme in SSAC technique for the treatment of intracranial WNBA could lead to the same complete occlusion degree and better outcome as DSAC technique with few complications.

To investigate the safety and effectiveness of stent semi-release assisted embolization in the treatment of ruptured tiny wide-necked intracranial aneurysms.

A retrospective analysis was conducted on the clinical data of 102 patients with acute (time interval from aneurysm rupture to treatment ≤7 days) ruptured tiny wide-necked intracranial aneurysms (maximum diameter of aneurysm ≤3 mm) admitted to the Department of Neurosurgery, Xingtai People′s Hospital from February 2018 to February 2022. All aneurysms were embolized with stent-assisted semi-release embolization technique. The Raymond grading scale was used to evaluate the embolization effect of aneurysms (grade Ⅰas complete embolization, grade Ⅱ as near-complete embolization, and grade Ⅲ as partial embolization). The procedure-related complications were observed. The modified Rankin scale (mRS) was used to evaluate the clinical outcomes of patients (0-2 as good outcome and ≥3 as poor outcome).

The preoperative mRS of 102 patients was 0 in 61 cases (59.8%), 1 in 19 cases (18.6%), 2 in 9 cases (8.8%), 3 in 8 cases (7.8%), and 4 in 5 cases (4.9%).The operations of 102 patients were successfully performed. Immediate postoperative angiography showed Raymond gradeⅠ embolization in 69 cases (67.7%), grade Ⅱ embolization in 30 cases (29.4%), and grade Ⅲ embolization in 3 cases (2.9%). Among them, 4 cases (3.9%) had stent thrombosis, 6 cases (5.9%) had local stenosis of parent artery, and no neurological deficit symptoms were left after operation. All patients were followed up for 3-12 months after discharge, and the follow-up time was 7.4±1.4 months. The mRS at the last follow-up was 0 in 84 cases (82.4%), 1 in 6 cases (7.8%), 2 in 6 cases (5.9%), and 3 in 4 cases (3.9%). Compared with the preoperative mRS, the difference was statistically significant (P<0.01). The last DSA evaluation of patients showed Raymond gradeⅠembolization in 94 cases (92.2%), gradeⅡembolization in 8 cases (7.8%), and grade Ⅲ embolization in 0 cases, and the difference was statistically significant compared with the immediate postoperative grading (P<0.01). Aneurysm recurrence occurred in 5 cases, and the recurrence rate was 4.9%. No aneurysm rebleeding or cerebral infarction occurred during the follow-up period.

Stent semi-release assisted embolization in the treatment of ruptured tiny wide-necked intracranial aneurysms has a low incidence of perioperative complications, a good short-term postoperative effect and a low recurrence rate.

To investigate the application value of tirofiban in patients with intracranial aneurysms treated by stent implantation.

A retrospective analysis was performed on 213 patients who underwent stent treatment of 219 intracranial aneurysms at the Department of Interventional Neurology, Liaocheng Third People′s Hospital from December 2019 to August 2023. Among them, 207 cases were treated with stent-assisted coil embolization, 4 cases were treated with Willis covered stents, and 2 cases were treated with Pipeline stents. After intraoperative stent placement, all patients were given low-dose tirofiban through the intermediate catheter, while tirofiban was continuously pumped intravenously. Digital subtraction angiography (DSA) was reviewed immediately after surgery to observe the embolization of the aneurysm, the patency of the target blood vessel, and whether there was cerebral infarction or cerebral hemorrhage, and perioperative surgical complications were recorded. Aneurysms treated with Pipeline stent implantation were evaluated with the O′Kelly-Marotta (OKM) grade for immediate occlusion, and other aneurysms were evaluated with the Raymond grade. The modified Rankin scale(mRS) was used to evaluate the patient′s prognosis 90 days after surgery, and imaging was used to evaluate whether aneurysm recurrence during the follow-up period was present.

A total of 213 stents were placed in 219 aneurysms, all of which were accurately positioned and released, with a technical success rate of 100%. Five aneurysms were embolized with Pipeline stent, and their OKM classification was all grade B. Among the remaining 214 aneurysms, 138 (64.5%) were graded Raymond grade Ⅰ (complete embolization), and 39 (18.2%) were grade Ⅱ (subtotal embolization), and 37 cases (17.3%) were grade Ⅲ (incomplete embolization). Among the 213 patients, 3 cases (1.4%) developed symptomatic cerebral hemorrhage, of which 1 case died, and the other 2 cases had follow-up mRS of 0 and 1 points respectively 90 days after surgery. Cerebral infarction secondary to stent thrombosis occurred in 7 cases (3.3%), of which 1 died and the remaining 6 cases had mRS of 0 to 2 points at 90-day follow-up. At 90 days after surgery, 202 cases (94.8%) had a good outcome (mRS of 0 to 2 points) and 11 cases (5.2%) had a poor outcome (mRS of 3 to 6 points). At 6 months after surgery, imaging follow-up was conducted for 98 aneurysms, and the recurrence rate of aneurysms was 3.1% (3/98).

In stent placement surgery to treat intracranial aneurysms, low-dose tirofiban administered through the artery and continuously administered intravenously is safe. The rates of in-stent thrombosis and symptomatic cerebral hemorrhage are low, leading to satisfactory outcomes.

To analyze the role of aggressive angioplasty in the treatment of intracranial atherosclerotic disease(ICAD)-related acute large vessel occlusion stroke (LVOS).

From the ANGEL-ACT database, 475 patients with ICAD-related LVOS were included and divided into two groups based on the treatment approach: the aggressive angioplasty group [defined as angioplasty performed after one mechanical thrombectomy (MT), or angioplasty alone] (194 cases) and the passive angioplasty group (defined as MT alone, or angioplasty performed after ≥2 MT attempts) (281 cases). The efficacy and safety between the two groups were compared. The primary efficacy endpoints were immediate post-procedure modified Thrombolysis in Cerebral Infarction (mTICI) grade (≥2b indicating successful reperfusion) and modified Rankin Scale (mRS) score at 90 days post procedure. Safety endpoints included symptomatic intracranial hemorrhage within 24 hours post procedure and mortality at 90 days post procedure. Binary logistic regression was used to analyze the odds ratios (OR) for those endpoints between the passive and aggressive angioplasty groups, with P<0.05 indicating statistical significance.

Among the 475 patients, the symptomatic intracranial hemorrhage rates within 24 hours post procedure were 3.1% (6/194) in the aggressive angioplasty group and 5.0% (14/281) in the passive angioplasty group (P=0.329). The immediate post procedure mTICI grade ≥2b rates were 96.9% (188/194) in the aggressive angioplasty group and 91.8% (258/281) in the passive angioplasty group (P=0.023). At 90 days post procedure, the rates of mRS 0-1 were 55.7% (108/194) in the aggressive angioplasty group and 38.8% (109/281) in the passive angioplasty group (P<0.001), with mortality rates of 10.8% (21/194) and 18.9% (53/281) respectively (P=0.018). After adjusting for age, sex, preoperative National Institutes of Health Stroke Scale score, atrial fibrillation, primary hypertension, and tandem lesions, binary logistic regression analysis showed an OR of 1.82 (95%CI: 1.00-3.31, P=0.051) for 90-day mortality and an OR of 0.55 (95%CI: 0.37-0.82, P=0.004) for mRS 0-1 in the passive angioplasty group compared with the aggressive angioplasty group. The OR value for achieving mTICI grade 2b-3 was 0.33 (95%CI: 0.13-0.85, P=0.022).

Early aggressive angioplasty in patients with ICAD-related acute large vessel occlusion reduces 90-day mortality and improves neurological functional recovery and cerebral reperfusion, demonstrating superior efficacy and safety.

To construct and validate a prognostic model for predicting the prognosis of isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) patients based on the radiomic features of multiparametric MRI.

A retrospective analysis was conducted on clinical information and MRI data from patients pathologically diagnosed with adult-type IDH wild-type GBM patients who underwent tumor resection surgery at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University (dataset 1, n=172 cases, from October 2018 to December 2020), and at the Department of Neurosurgery, Henan Provincial People′s Hospital (dataset 2, n=89 cases, from January 2011 to September 2021). After preprocessing multiple MRI sequences, including T1-weighted imaging, gadolinium-enhanced T1-weighted imaging, T2-weighted imaging, fluid-attenuated inversion recovery sequences, diffusion-weighted imaging, and apparent diffusion coefficient maps, dataset 1 was divided into a training set and an internal validation set at a ratio of 1 ∶1. Dataset 2 was used as an external validation set. A univariate Cox proportional hazards regression model combined with Lasso-cox analysis was employed to select radiomic features. These radiomic features were integrated with clinical risk factors to develop a clinic-radiomic model for predicting the prognosis of GBM patients. The predictive performance of the model was evaluated using the concordance index, Akaike information criterion (AIC), integrated discrimination improvement (IDI), Kaplan-Meier survival curves, nomograms, calibration curves, and decision curves and then was compared with that of the model established using clinical risk factors.

Eighteen radiomic features significantly associated with the prognosis of IDH wild-type GBM patients were selected to construct a radiomic model (Radscore). Kaplan-Meier survival curves demonstrated statistically significant prognostic differences between high-risk and low-risk groups stratified by Radscore in the training set, internal validation set, and external validation set (all P<0.05). Univariate and multivariate Cox proportional hazards regression analyses indicated that the Radscore was an independent prognostic factor in the training set (P<0.05). Compared with the clinical model alone, the addition of the Radscore improved the concordance index from 0.682, 0.682, and 0.791 to 0.785, 0.694, and 0.823, respectively, in the training set, internal validation set, and external validation set. The values of AIC decreased from 727.872, 703.796, and 666.732 to 683.771, 697.790, and 654.837, respectively. The IDI values for the clinic-radiomic model in the training set, internal validation set, and external validation set were 0.268, 0.051, and 0.100, respectively (all P<0.05). The clinic-radiomic model consistently demonstrated superior predictive performance on nomograms and calibration curves across the three subsets. Decision curves demonstrated that the incorporation of Radscore improved the decision-making ability of the clinical model.

The radiomic model established based on multiparametric MRI images using machine learning techniques can achieve risk stratification of IDH wild-type GBM patients and enhance the prognostic predictive ability of traditional clinical models to some extent.

We used resting-state functional MRI (rs-fMRI) to explore the difference in regional homogeneity (ReHo) of spontaneous brain functional activity in patients with primary glossopharyngeal neuralgia (GPN) and healthy control subjects in the resting state and thus to explore the central pathogenesis of GPN from the perspective of brain function.

Clinical data and rs-fMRI images of 23 patients with right-sided primary GPN who were admitted to Department of Neurosurgery, Peking University People′s Hospital from January 2020 to June 2023 were prospectively collected and compared with 23 healthy control subjects matched for age, sex, and education. We used SPM12 and RESTplus softwares to process the rs-fMRI images and calculate ReHo values for functional brain activity. A two-sample independent t-test was performed on the data to compare brain areas that were significantly different between the two groups of subjects. GPN patients were stratified and subgrouped according to the presence or absence of neurovascular compression. P values were corrected for multiple comparisons using the AlphaSim method. Pearson correlation analysis was used to further assess the correlation between ReHo values and clinical indicators including age, duration of disease, extent of pain (based on visual analogue scale, VAS) in the differential brain regions.

Compared with healthy controls, GPN patients had significantly higher ReHo values (all P<0.05) in the following brain regions: left thalamus, precentral gyrus, postcentral gyrus; right insula, superior temporal gyrus, middle temporal gyrus, precentral gyrus, postcentral gyrus. GPN patients had significantly lower ReHo values (both P<0.05) in the bilateral anterior cingulate gyrus. Compared with GPN patients with neurovascular compression, GPN patients without neurovascular compression had significantly higher ReHo values in the bilateral precentral and postcentral gyrus (all P<0.05) and lower ReHo values in the bilateral anterior cingulate gyrus (both P<0.05). The change in ReHo values in the bilateral anterior cingulate gyrus was significantly negatively correlated with the VAS scale score (r=-0.47, P=0.024).

In patients with GPN, there are significant coordination abnormalities in several brain regions involved in pain processing, which are mainly manifested as abnormal synchronous excitation of the thalamus, insula, precentral gyrus, and postcentral gyrus involved in the upward transmission of pain and central processing, and weakening of the anterior cingulate gyrus with a downward inhibitory effect on pain. The imbalance between the excitability and inhibitability of the upward pain transmission pathway and the downward inhibitory pathway jointly cause abnormal pain regulation function in GPN patients, and the onset of GPN may be the result of both peripheral stimulation and central excitation.

To investigate the influence of pneumocephalus on electrode position following deep brain stimulation for Parkinson′s disease.

A retrospective study was conducted on 78 patients with Parkinson′s disease who underwent bilateral deep brain stimulation of the subthalamic nucleus between May 2021 and October 2022 at the Department of Neurosurgery, the Secondary Affiliated Hospital, Zhejiang University School of Medicine. Thin-slice CT scan was performed in the early (within 1 day) and late (1 month) postoperative periods respectively. The volume of pneumocephalus and the deviation between the electrode and the target were calculated. The coordinate difference between the early and late postoperative periods was calculated at an axial level 4 mm below the anterior and posterior commissure. X represented the lateral or medial distance to the AC(anterior commissure)-PC (posterior commissure) line (positive for the lateral and negative for the medial); Y represented the distance in the direction of AC-PC line (positive for the anterior and negative for the posterior). The deviation of the electrode position caused by the absorption of intracranial pneumocystis within 1 month after surgery was evaluated, and the correlation between intracranial pneumocephalus and the coordinate difference was analyzed.

Median volume of pneumocephalus for a cohort of 78 patients was measured to be 1.08 (0.22, 3.02) cm³ in the early postoperative period, the median volume of pneumocephalus for the left and right sides were observed to be 0.24 (0.00, 0.94) cm³ and 0.48 (0.06, 1.62) cm^3, respectively. There was no significant difference on the left (1.40±0.61 mm vs. 1.30±0.55 mm, P= 0.299) or the right (1.08±0.52 mm vs. 1.19±0.57 mm, P=0.190) deviations of electrodes from the intended target between early and late postoperative periods. The difference in electrode coordinates between late and early postoperative was as follows: left side ΔX=0.41±0.52 mm, ΔY=1.00 (0.70, 1.50) mm; right side ΔX=0.43±0.50 mm, ΔY=1.00 (0.70, 1.30) mm. The left intracranial air volume was correlated with left ΔX (r=0.17, P=0.039) and ΔY (r=0.24, P = 0.003). The right intracranial air volume was not correlated with right ΔX (r = 0.10, P = 0.388) but correlated with right ΔY (r = 0.44, P < 0.001).

Our findings indicate that following deep brain stimulation in patients with Parkinson′s disease, the electrode position shifts forward and laterally due to the absorption of intracranial air and the restitution of brain tissue.

To investigate the evaluation of surgical efficacy of cranial tinnitus with internal jugular vein (IJV) compressed by transversal process or styloid process of atlas with color doppler ultrasound (CDU).

The clinical data of 8 patients with cranial tinnitus due to IJV stenosis admitted to the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from September 2020 to March 2023 were analyzed retrospectively. All patients with IJV stenosis due to compression of transversal process or styloid process of atlas were confirmed by computer tomography venography(CTV). After the surgery of partial decompression of the transversal process or styloid process of atlas, CDU examinations were performed 1 week before surgery, within 1 week after surgery, and 3-6 months after surgery to observe the changes of the maximum diameter, the mean flow volume(FVm) and the maximum velocity(Vmax) of the IJV.

There was no statistical significance in the diameter or FVm of each part of IJV in 8 patients within 1 week after surgery (all P>0.05). At 3-6 months post surgery, the maximum diameter of the IJV at J1 and J2 were increased significantly compared with before [J1: 9.52±2.09 mm vs. 7.45 ±2.10 mm, J2: 6.75±1.74 mm vs. 5.52±1.91 mm] (both P<0.05), whereas the difference in J3 was not significant(P>0.05). The FVm of IJV was improved compared with before [J1: 349.20±188.99 ml/min vs. 204.60±118.50 ml/min, J2: 193.10±91.32 ml/min vs. 124.50±81.57 ml/min, J3: 152.70±95.71 ml/min vs. 61.90±53.23 ml/min) (all P<0.05). There was no statistical significance in the parameter of Vmax of IJV compared with before (P>0.05).

For patients of cranial tinnitus caused by IJV stenosis compressed by bone structure, the preliminary observation has indicated that the surgery of partial decompression of the transversal process or styloid process of atlas may improve the lumen and hemodynamics of the narrow part of IJV. CDU can be used as an objective method to evaluate the effect of surgical treatment of IJV stenosis compressed by bone structure.

To investigate the clinical application of CT venography (CTV) in the assessment of therapeutic effect of internal jugular vein stenosis decompression surgery for recurrent tinnitus.

Sixteen tinnitus patients undergoing internal jugular vein stenosis decompression surgery were recruited from September of 2020 to December of 2022. CTV image quality and the internal jugular vein stenosis were evaluated with subjective and objective indices, and objective indices included CT values, signal to noise ratio (SNR) and contrast to noise ratio (CNR). The subjective assessments were evaluated by two radiologists blindly with image quality scores systems (1 to 4 scores, with the higher score indicating higher image quality). Kappa analysis was used to analyze the consistency of the two radiologists. CTV was used to follow up the recovery of the stenotic vein lumen 6 months after surgery (the lumen circumference widened by >50%).

The objective index of image quality for sixteen internal jugular vein stenosis patients before and after surgery were as follows: CT value(277.5±20.0 HU vs. 280.0±19.7 HU), SNR (9.1±3.0 vs. 8.4±3.0), CNR (4.1±2.7 vs.4.2±2.7), while the subjective assessments were 0.82 and 0.81 with kappa analysis, including 14 patients graded as 4 points, 2 patients as 3 points, whereas 12 patients as 4 points, with 4 patients as 3 points. Three cases of bilateral and 13 cases of unilateral internal jugular vein stenosis were found, including 4 in the left side and 9 in the right side. The predilection site of stenosis lied in the transverse process of atlas, with 9 patients for hyperosteogeny of transverse process of transverse process of atlas, and 7 patients for vein travelling between the transverse process of atlas and styloid process. After surgery, 12 patients showed internal jugular veins dilated, with 6 patients had alleviation, while 4 patients reported no recovery of internal vein stenosis for the adhesion of local scar tissues.

CTV demonstrates clinical applications in the diagnosis and therapeutic effects for internal jugular vein stenosis. The bony structure of transverse process of atlas is the anatomical basis of predilection factor.

To investigate the effect of electroacupuncture (EA) on the proliferation and differentiation of endogenous neural stem cells (eNSCs) and its relationship with protein kinase B/glycogen synthase kinase-3β/camp response element binding protein (AKT/GSK-3β/CREB) signaling pathway after spinal cord injury (SCI).

A total of 48 C57BL/6 mice were randomly divided into sham group, SCI group, SCI+ EA treatment group and SCI+ EA+ AKT inhibitor MK2206 treatment group, with 12 mice in each group. The sham group only underwent laminectomy, and the T_8-9 spinal cord transection model was established in the other three groups. On the 7th day after SCI, immunofluorescence staining was used to detect Ki-67 and Nestin to evaluate the proliferation of eNSCs, and the Western blot (WB) was used to detect the expression of Nestin protein. On the 14th day after SCI, nerve growth-associated protein (GAP-43) and Ki-67 were detected by immunofluorescence staining to evaluate the differentiation of eNSCs into neurons, and glial fibrillary acidic protein (GFAP) was detected to evaluate the activation of astrocytes at the injury site. WB was used to measure the protein expression levels of GAP-43 and AKT/GSK-3β/CREB signaling pathway.

The success rate of model building was 94.7%(36/38). Compared with the Sham group, the SCI group had a significant increase in the number of Nestin/Ki-67 positive double cells (P<0.05). Compared with the SCI group, the number of Nestin/Ki-67 double positive cells and GAP-43/Ki-67 double positive cells increased significantly in the EA group, and the number of GFAP positive cells decreased (all P<0.05). WB results showed that the expression of Nestin and GAP-43 in the EA group was significantly higher than that in the SCI group (both P<0.05). Compared with Sham group, the phosphorylation level of GSK-3β in SCI group was decreased (P<0.05), and the phosphorylation level of AKT and CREB was not significantly different (both P>0.05). Compared with SCI group, the phosphorylation levels of AKT, GSK-3β and CREB in EA group were significantly increased (all P<0.05). The phosphorylation levels of AKT, GSK-3β and CREB in the EA+ MK-2206 group were significantly lower compared with those in the EA group (all P<0.05), and there was no significant difference between the EA+ MK-2206 group and the SCI group (all P>0.05).

EA treatment can promote the proliferation and neuronal differentiation of eNSCs after SCI, and inhibition of AKT activation can inhibit that after SCI. It is suggested that the mechanism of EA treatment may be related to the AKT/GSK-3β/CREB pathway.

To investigate the growth and development of skull in rapidly growing SD rats and it′s relationship to FAK-Twist1 signaling pathway in the skull and dura mater.

We selected young rats and started from 1 week after birth to document the cranial length and cranial width using a soft ruler. An electronic scale and electronic balance were used to weigh the body weight and brain weight of rats. A graduated cylinder was used to weigh the volume of brain tissue. Western blotting was performed to detect the expression changes of FAK in the skull and Twist1 in the dura mater. Immunohistochemistry and immunofluorescence were used to observe the cell morphology of the skull and dura mater tissues and the expression differences of FAK-Twist1 in different parts.

(1) The cranial length and width of the rat skull increased gradually from 1 to 7 weeks (F_{cranial length}=420.20、F_{cranial width}=47.27, both P<0.001). Compared with the first week, the length and width of the skull increased significantly in the second week (all P<0.05), and the two lines increased by 94.4% and 90.0% of the whole skull development (1-12 weeks) respectively in the seventh week; (2) The body weight and brain weight of rats increased gradually from 1 to 7 weeks (F_{body weight}=485.20、F_{brain weight}=126.00, both P<0.001). Compared with the first week, there was a significant increase in body weight and brain weight in the second week (all P<0.05). In the seventh week, body weight and brain weight increased by 60.4% and 51.2% of the whole development respectively; (3) The brain volume of rats increased gradually from 1 to 7 weeks (F=852.80, P<0.001), rapidly from 1 to 3 weeks, and relatively slowly after 3 weeks. Compared with the first week, the brain volume increased by 60.45% of the whole development in the seventh week; (4) The results of WB showed, at weeks 1-7, the expression of FAK in the skull tissue gradually increased (F=15.80, P<0.001), and FAK was significantly increased in week 7 compared with week 1 (P<0.01). FAK in the dura mater tissue showed a trend of first decreasing and then increasing, reaching its highest value in week 4 compared to week 1, with statistical significance (P<0.05). The correlation coefficients between FAK expression level and cranial length and cranial width were 0.95 and 0.96, respectively (both P<0.001), showing positively correlated relationships; (5) Cranial suture observation results showed that the skull growth of neonatal SD rats was mainly longitudinal at the 1st, 4th and 7th week after birth, and cranial suture was gradually clear and completely closed at the 7th week; (6) The results of immunocombination and immunofluorescence showed that Twist1 was mainly expressed in the dura, the highest expression in the first week, and then gradually decreased (F_{histochemistry}=22.10, F_fluorescence=36.82, both P<0.01). FAK was mainly expressed in the skull, and its expression level was decreased at week 4 compared to week 1(P<0.01), and then gradually increased.

From 1 to 7 weeks after rats birth, the expression of FAK in the skull and dura is positively correlated with the growth and development of the skull, while the expression of Twist1 in the skull and dura decreases with the growth and suture closure of the skull. FAK/Twist1 in the skull and dura may jointly regulate the growth and development of the skull and suture closure of the young rat.

To systematically review the influence of intraoperative ultrasound on surgical outcomes of patients with gliomas.

PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang databases were electronically searched to identify cohort studies investigating the influence of intraoperative ultrasound on surgical outcomes of patients with gliomas, which were published between January 1, 2013 and December 31, 2023. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted using RevMan 5.4 software and Stata 16.0 software. The primary outcome measure was gross total resection (GTR) rate, and the secondary outcome measures were surgical duration and postoperative Karnofsky performance status score. The χ² test and I² value were used to evaluate the heterogeneity between the results of included studies. In case of P<0.05 or I²>50%, the random effect model would be used to calculate the effect size. Otherwise, the fixed effect model would be used to calculate the effect size.

A total of 17 cohort studies were included in the analysis, incorporating 1 364 glioma patients. The results of meta-analysis showed that compared with the conventional surgery group (634 cases), the intraoperative ultrasound group (730 cases) had a higher GTR rate (RR=1.52, 95%CI: 1.38-1.66, P<0.001), a shorter surgical duration (SMD=-0.60, 95%CI: -0.96 - -0.23, P=0.001), and a higher postoperative Karnofsky performance status score (SMD=0.76, 95%CI: 0.43-1.09, P<0.001).

The use of intraoperative ultrasound can improve surgical outcomes and shorten surgical duration of patients with gliomas.

At present, endovascular therapy has become the main treatment for intracranial aneurysms. However, for complicated aneurysms such as wide neck and rupture of intracranial bifurcation, it is difficult to obtain good prognosis with traditional endovascular treatment. Designed for the treatment of complex intracranial aneurysms, the Woven EndoBridge (WEB) device is currently the most commonly used intratumoral turbulence device. Compared with traditional endovascular therapy, WEB devices are not only simple to operate, but also have the advantages of higher metal coverage and lower complication rate. This article mainly reviews the clinical prognosis of WEB device in the treatment of complex intracranial aneurysms, in order to provide evidence-based evidence for the clinical treatment of this kind of diseases.

Spinal cord injury can lead to temporary or permanent motor and sensory dysfunction in patients, which not only brings great pain and inconvenience to patients, but also brings unpredictable economic burden to society and families. With the continuous progress of science and technology, machine learning has been applied to the diagnosis, treatment and rehabilitation of spinal cord injury. Clinicians can use existing data to build models to guide diagnosis, treatment and rehabilitation more efficiently and accurately. This article reviews the application progress of machine learning in the diagnosis and treatment of spinal cord injury in recent years, in order to provide help for the clinical treatment of this disease.

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes, which mainly involves the sensory nervous system. Diabetic peripheral nerve pain (DPNP) is the most common factor that urges patients to seek medical treatment, and the forms of pain are diverse, with burning pain in both lower limbs being more common, and its pathological mechanism is complex, which is the focus and difficulty of treating diabetic complications at present. At present, there is no effective treatment for DPN and DPNP. Peripheral nerve decompression provides a new treatment option for patients with lower extremity DPNP, but its clinical application is still controversial. Therefore, this article mainly focuses on the pathological mechanism of DPNP, the theoretical basis and clinical application evidence of peripheral nerve decompression in the treatment of DPNP, the grasp of surgical indications and the progress of basic research.