Volume 40 · Issue 08 · 2024

intracranial aneurysm (IA) is a hemangioma formed by pathological bulging of the weak part of the intracranial blood vessel wall. With the inclusion of magnetic resonance angiography (MRA) and CT angiography (CTA) in health screening and widespread application, the detection rate of IA has increased^[1]。 The combined prevalence of unruptured intracranial aneurysms (UIAs) is about 3.2%^[2], a cross-sectional study based on community populations in Shanghai showed that the rate of UIAs detected by MRA was as high as 7% among people aged 35 to 75, with females higher than males^[3]。 ruptured intracranial aneurysms (RIAs) are the most common cause of subarachnoid hemorrhage (SAH), accounting for about 85%^[4]The fatality and disability rate of patients can reach 50%^[5,6]。 The Phase I study of the International Study of Unruptured Intracranial Aneurysms (ISUIA) showed that the annual rupture rate of UIAs was 0.95%, and the larger the maximum diameter of IA, the higher the risk of rupture^[7]。 Therefore, it is particularly important to detect IA as early as possible and evaluate its rupture risk. Based on this, this guide summarizes the commonly used imaging techniques and emerging technologies for IA screening and risk assessment, and strives to recommend the most suitable imaging techniques to guide the diagnosis and treatment of clinical IA.

Glioma is the most common central nervous system (CNS) tumor in children, among which low-grade glioma is the most common, accounting for about 25% to 40% of childhood nervous system tumors^[1,2,3]。 At present, there is still a lack of epidemiological investigation reports for children in China. According to many domestic data, the annual incidence rate of CNS tumors in children is 2.10/100,000~2.59/100,000, among which the annual incidence rate of pediatric low-grade glioma (PLGG) is about 0.53/100,000~0.65/100,000^[2]。 Different from adults, children's nervous system is still in the developmental stage, and glioma occurring in children has its unique molecular pathological characteristics and mechanisms; Therefore, the 2021 World Health Organization (WHO) CNS Tumor Classification separately designated it as "childhood diffuse low-grade glioma" and "childhood diffuse high-grade glioma". At the same time, localized gliomas and glial neuronal tumors in the WHO classification are also more likely to occur in children. This guideline mainly deals with localized gliomas, diffuse low-grade gliomas, and glial neuronal tumors in the 2021 WHO classification; Except for spinal cord PLGG, all of them are evidence-based medical evidence and diagnosis and treatment recommendations for intracranial PLGG.

To explore the clinical risks associated with cognitive function status in adults patients of moyamoya disease presenting with transient ischemic attack (TIA-MMD).

The clinical data of 72 adult patients with TIA-MMD who did not undergo revascularization and admitted to the Neurosurgery Department of Huadong Hospital Affiliated to Fudan University from March 2020 to June 2022 were retrospectively analyzed. The cognitive function of the patients was evaluated through the Montreal Cognitive Assessment (MoCA) score, and based on the scores, TIA-MMD patients were divided into a normal cognitive function group and a cognitive impairment group. During the patient′s hospitalization, 3.0T MRI was performed to analyze the white matter hyperintensity volume (WMHV), and brain CT perfusion imaging (CTP) was also performed. The differences in clinical data and WMHV and CTP-related parameters between the two groups were compared by univariate analysis. Furthermore, the statistically significant factors in the univariate analysis were included in multivariate regression analysis.

According to the MoCA scale, the cognitive function score of this cohort of patients was 24.85±3.95 points (17-30 points), including 35 patients in the normal function group (MoCA≥26 points) and 37 patients in the cognitive impairment group (MoCA< 26 points). According to univariate analysis, patients in the cognitive dysfunction group had a higher proportion of people with low education level (P=0.002), higher WMHV (P<0.001), and longer mean transit time (MTT), time to peak (TTP), time to maximum (Tmax) at the left temporal point of interest (all P<0.001). The results of multivariate logistic regression analysis showed that increased WMHV was an independent risk factor for cognitive impairment in patients with TIA-MMD (OR=1.33, 95%CI: 1.03-1.74, P=0.032).

Increased volume of WMHV on MRI is an independent risk factor for cognitive impairment in patients with TIA-MMD, and can be used as one of the routine clinical monitoring indicators for patients with MMD.

To preliminarily observe the safety and effectiveness of the swinging-tail technique in assisting coil embolization of wide-neck aneurysms of the posterior communicating artery (PCoA) with fetal-type posterior cerebral artery (fPCA).

The clinical data of 14 patients with wide-neck aneurysms of the PCoA with fPCA who were treated with the swinging-tail technique to assist coil embolization in the Department of Neurointerventional Radiology, the First Affiliated Hospital of Zhengzhou University from August 2018 to August 2023 were retrospectively analyzed. Technical and operation-related complications were observed. At 6 months post operation, telephone or outpatient follow-up was conducted and patients were reminded to undergo the scheduled whole-brain digital subtraction angiography (DSA). The neurological function status was evaluated by the modified Rankin Scale (mRS), and the embolization effect of the aneurysm was evaluated by Raymond classification.

All 14 patients achieved technical success, and no operation-related complications occurred. One patient died due to respiratory failure 16 days after the operation. At discharge, there were 11 cases with mRS 0 point, 1 case with mRS 1 point, and 1 case with mRS 2 points. At the 6-month follow-up after the operation, the mRS scores of 13 patients were all 0 point. Eleven patients completed DSA follow-up, and the follow-up time [M(Q₁, Q₃)] was 7 (5, 10) months; the results showed that the PCoA was all well opened, and there was no in-stent stenosis, among which there were 8 cases of Raymond grade Ⅰ and 3 cases of grade Ⅱ. Only two patients underwent the examination of magnetic resonance angiography, and no aneurysm recurrence was seen.

Preliminary observation has demonstrated that the use of the swinging-tail technique to assist coil embolization of wide-neck aneurysms of the PCoA with fPCA has fewer surgical complications and can effectively embolize the aneurysm.

To explore the safety and effectiveness of Enterprise 2 stent implantation in the endovascular recanalization treatment of atherosclerotic acute middle cerebral artery (MCA) occlusion.

A retrospective analysis was performed on the clinical data of 71 patients with acute ischemic stroke (AIS) caused by atherosclerotic acute MCA occlusion who were admitted to the Neurointerventional Department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to December 2022. Among them, 46 patients underwent balloon dilation combined with Enterprise 2 stent implantation (stent implantation group), and 25 patients underwent balloon dilation alone (balloon dilation group). The modified Thrombolysis in Cerebral Infarction (mTICI) grade was used to evaluate the degree of postoperative vascular recanalization (mTICI ≥ grade 2b indicated successful recanalization). Perioperative complications were documented, and the National Institute of Health Stroke Scale (NIHSS) was used to evaluate patients. Neurological function on the 7th day after surgery (NIHSS ≥4 points as compared with pre-operation was considered neurological improvement), and modified Rankin scale score (mRS) was used to evaluate the patient′s outcome on the 90th day after surgery (mRS≤2 points indicated good outcome). The presence or absence of vascular restenosis during the follow-up period was assessed by imaging, and the differences between the two groups were compared.

All 71 patients achieved successful recanalization of blood vessels. Thirty-six cases in the stent implantation group and 17 cases in the balloon dilation group were followed up, and the follow-up time ranged from 3 to 12 months. There were no statistically significant differences between the two groups of patients in terms of age, gender, risk factors related to cerebrovascular disease, whether intravenous thrombolysis was performed, preoperative NIHSS score, whether mechanical thrombectomy was performed, time from onset to femoral artery puncture, or operation duration (all P>0.05). Compared with the balloon dilatation group, the perioperative distal vessel embolization rate in the stent implantation group [4.3% (2/46) and 20.0% (5/25) respectively], and the incidence rate of in-stent restenosis during the follow-up period (4/36 and 6/17 respectively) were lower (both P<0.05). There were no statistically significant differences between the two groups in the degree of immediate successful recanalization of blood vessels, the immediate rate of residual stenosis, the incidence of symptomatic intracranial hemorrhage or death within 1 week after surgery, the neurological function improvement rate 1 week after surgery, or the proportion of good outcome 90 days after surgery (all P>0.05).

For patients with AIS caused by atherosclerotic acute MCA occlusion, the efficacy of Enterprise 2 stent implantation may be non-inferior to that of simple balloon dilatation, with fewer complications.

To comparatively analyze the efficacy of stereotactic soft-channel aspiration surgery and hard-channel aspiration surgery in treating primary brainstem hemorrhage.

We retrospectively analyzed the clinical data of 146 patients with primary brainstem hemorrhage who were treated with stereotactic soft-channel aspiration surgery (n=65, soft-channel group) and hard-channel aspiration surgery (n=81, hard-channel group) at the Department of Neurosurgery of the First Hospital of Hebei Medical University from August 2014 to August 2023. Postoperative immediate head CT scan was performed to evaluate residual hematoma volume, and the duration of postoperative hematoma cavity drainage tube placement was documented. Follow-up assessments included the survival status of patients at 30 days post-operation, and the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) grades at 90 days post-operation. The mRS scores of 0-3 were considered as good neurological recovery, and GOS grades Ⅳ-Ⅴ as favorable outcomes.

There were no statistically significant differences between the soft-channel and hard-channel groups in terms of gender, age, or preoperative Glasgow Coma Scale (GCS) scores (all P>0.05). All surgeries were successfully completed without postoperative rebleeding or other surgery-related complications. Compared with the soft-channel group, the hard-channel group had a significantly smaller immediate postoperative residual hematoma volume [M(Q₁, Q₃): 0 (0, 0.3) ml vs. 3.5 (0.5, 4.4) ml, Z=-7.54, P<0.001], shorter duration of postoperative hematoma cavity drainage tube placement [M(Q₁, Q₃): 1 (1, 2) d vs. 3 (2, 4) d, Z=-7.09, P<0.001], lower mortality rate at 30 days post-operation [14.8%(12/81) vs. 41.5%(27/65), χ²=20.19, P=0.035], and a higher proportion of patients with good neurological recovery [32.1%(26/81) vs. 18.5%(12/65), χ²=4.78, P=0.047]. However, there was no statistically significant difference in the outcome at 90 days post-operation between the two groups (χ²=6.28, P=0.189).

Hard-channel aspiration surgery for primary brainstem hemorrhage offers advantages over stereotactic soft-channel aspiration surgery in terms of more effective hematoma removal, reduced postoperative residual hematoma volume and mortality rate, and improved neurological function.

To investigate the classification and clinical characteristics among different types of symptomatic tinnitus caused by head and neck venous stenosis based on CT venography (CTV).

From September 2020 to December 2022, a total of 43 patients were diagnosed as head and neck venous stenosis based on CTV imaging at Beijing Shijitan Hospital, Capital Medical University. All patients had tinnitus as the main symptom. According to CTV imaging, venous stenosis of the head and neck was divided into intracranial venous sinus type, internal jugular vein type and composite type (intracranial venous sinus-internal jugular vein combined stenosis type). Differences in the imaging demonstrations and some clinical characteristics of the patients with those 3 types were retrospectively analyzed.

Among the 43 patients, 14 (32.6%) belonged to the intracranial venous sinus type, of which 10 cases had stenosis located in the transverse sinus, caused by arachnoid granule hyperplasia and compression; 4 cases had linear stenosis at the transition between the confluence of sinuses and the transverse sinus. There were 16 cases (37.2%) of internal jugular vein type, and the stenosis was all located in the transverse process segment of the atlas. Among them, 6 cases were caused by hyperplasia of the transverse process of the atlas and compression stenosis, and 10 cases were caused by the internal jugular vein running between transverse process of the atlas and the styloid process, resulting in local lumen compression and stenosis. There were 13 cases (30.2%) of the composite type. The stenosis was located in the transverse sinus and the transverse process segment of the atlas. Among them, 3 cases had stenosis at the confluence of sinuses and the transitional part of the transverse sinus. Ten cases had arachnoid granule hyperplasia compressing the transverse sinus. Among them, 3 cases had a single stenosis. The lateral intracranial venous sinuses and internal jugular veins were small throughout. The proportion of female patients with intracranial sinus type was higher than that of internal jugular vein type and composite type, and the disease duration was shorter than that of internal jugular vein type and composite type (all P<0.05). There were no statistically significant differences in age and side of stenosis among patients with the three types of classification (all P>0.05).

Based on CTV, the three types of symptomatic tinnitus caused by head and neck venous stenosis have similar composition ratios, among which arachnoid granule compression is a common cause of intracranial sinus stenosis and bone hyperplasia compression is a common cause of internal jugular vein type. In some patients, the stenosis may be related to congenital developmental factors. The clinical characteristics of the three types of head and neck venous stenosis may be different.

To investigate the clinical efficacy of multimodal neuro-navigation combined with intraoperative sodium fluorescein (SFL) in the treatment of intracranial high-grade gliomas (HGG).

The clinical data of 47 patients with HGG (observation group) admitted to the Department of Neurosurgery of Inner Mongolia Autonomous Region People′s Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients underwent multimodal image fusion and a preoperative navigation plan was developed before surgery, and multimodal neuronavigation and sodium fluorescein were used to assist in tumor resection during surgery. A total of 47 patients with HGG who underwent tumor resection under microscopy from January 2012 to December 2017 were included as the control group. The baseline data, the degree of tumor resection, the postoperative newly-developed neurological deficits, the improvement of postoperative muscle strength and Karnofsky performance scale (KPS), and the occurrence of complications were compared between the two groups. The Kaplan-Meier survival curve was plotted, and the log-rank test was used to compare the survival of the two groups.

There were no significant differences in gender, age, tumor location and side, adjacent functional areas, World Health Organization grade of tumor, or preoperative KPS between the observation group and the control group (all P>0.05). The rate of total tumor resection, the rate of muscle strength improvement after surgery, and the KPS score at 3 months after surgery in the observation group were higher than those in the control group, and the differences were statistically significant (all P<0.05). The rate of newly-developed neurological dysfunction after surgery was lower than that of the control group (P<0.05). There were no significant differences in length of hospital stay, duration of surgery, or incidence of complications between the two groups (all P>0.05). The results of log-rank test showed that the survival rate of patients in the observation group at 6, 12 and 18 months (87.2%, 53.2% and 21.3%, respectively) was higher than that in the control group (63.8%, 27.6% and 10.6%, respectively) (all P<0.05), and the progression-free survival (4.00±1.91 months vs. 2.83±1.59 months) and overall survival (12.49±5.34 months vs. 9.26±5.79 months) were significantly greater than those in the control group (all P<0.05).

Compared with the traditional microscopic surgery, the resection of HGGs with the assistance of multimodal neuronavigation combined with intraoperative sodium fluorescein seems to be associated with a higher total resection rate, fewer complications, and better survival prognosis.

To investigate the survival of adult patients with lower grade gliomas (LGGs) and its influencing factors.

A retrospective analysis was performed on the clinical data of 156 cases of LGGs admitted to the Department of Neurosurgery of the Second Affiliated Hospital, Army Medical University from March 2015 to September 2021. Among 156 patients, there were 109 cases of WHO grade 2 and 47 cases of WHO grade 3. The clinical characteristics were compared between patients with isocitrate dehydrogenase (IDH)-wild type glioma and patients with IDH-mutant type glioma. Kaplan-Meier curve was drawn, and the survival of the two groups was compared by log-rank test. Univariate and multivariate Cox model analysis were used to determine the independent influencing factors affecting survival.

The age and proportion of patients having neurological deficits before surgery were significantly different between patients with IDH mutant and wild-type LGGs (both P<0.05). The Kaplan-Meier curve analysis showed that the 5-year overall survival (OS) and 5-year progression-free survival (PFS) of LGGs was 77.9% and 68.8%, respectively. Log-rank analysis showed that patients older than 42, presence of neurological deficits before surgery, WHO grade 3, astrocytoma, subtotal resection, IDH wild-type and Ki-67 proliferation index greater than 10% predicted worse OS for LGGs (all P<0.05), while >42 years old, WHO grade 3, astrocytoma, IDH wild-type and Ki-67 proliferation index greater than 10% predicted worse PFS for LGGs (all P<0.05). Multivariate Cox risk analysis showed that lower tumor grade (HR=0.30, 95%CI: 0.09-0.94, P=0.040), gross total resection (HR=0.31, 95%CI: 0.12-0.79, P=0.015), and IDH mutations (HR=0.24, 95%CI: 0.10-0.59, P=0.002) were independent protective factors for the OS of LGGs. Lower tumor grade(HR=0.39, 95%CI: 0.19-0.82, P=0.012)was independent protective factor for PFS of LGGs.

Gross total resection and lower tumor grade (WHO grade 2) are associated with good prognosis for LGGs, while IDH wild-type LGGs suggests worse prognosis.

To explore the long-term effects of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) in patients with mesial temporal lobe epilepsy.

A retrospective analysis was performed on the clinical data of 23 patients with mesial temporal lobe epilepsy who were treated with SEEG-guided RFTC at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from April 2019 to December 2020 and with a follow-up time of 36 months. All patients underwent a complete preoperative epilepsy evaluation of stage Ⅰ and stage Ⅱ, and an electrode placement plan was comprehensively designed based on symptomatology, electroencephalography, multimodal imaging and other data. The cases were determined to be mesial temporal lobe epilepsy, and SEEG electrodes were used for conformal damage. Outpatient or telephone follow-up was conducted at 3, 6, 12, 24, and 36 months after surgery. The modified Engel classification was used to evaluate the surgical efficacy. Modified Engel grade Ⅰ and Ⅱ were considered effective in RFTC treatment. During the follow-up period, if the patient underwent anterior temporal lobectomy surgery, the case was recorded as ineffective RFTC treatment. According to whether habitual seizures were induced by electrical stimulation before RFTC surgery, patients were divided into a group with habitual seizures induced and a group without habitual seizures induced. The frequency of epileptic seizures before and after surgery was compared between the two groups.

All 23 patients underwent successful RFTC surgery without obvious adverse events. At the 3-month follow-up after surgery, 14 cases (60.9%) were classified as Engel grade Ⅰ (60.9%), 8 (34.8%) as grade Ⅱ, and 1 (4.3%) as grade Ⅳ. The effective rate of RFTC treatment was 95.6% (22/23). Among them, all 14 patients with modified Engel classification grade Ⅰ had habitual seizures induced by preoperative electrical stimulation. During the follow-up period, 9 patients underwent anterior temporal lobectomy. The follow-up time after anterior temporal lobectomy [M (Q₁, Q₃)] was 26 (18, 30) months, and 8 patients reached modified Engel classification grade Ⅰa and 1 case was grade Ⅱ. As of the last follow-up, the effective rate of RFTC treatment was 13.0% (3/23). Compared with the group in which habitual seizures were induced (17 cases) and the group in which habitual seizures were not induced (6 cases), there was no statistically significant difference in the frequency of epileptic seizures before surgery [M (Q₁, Q₃): 6.00 (5.00, 10.00) times/month vs. 8.00 (5.25, 17.50) times/month, P=0.804]. The group with induced habitual seizures had a lower frequency of epileptic seizures 3 months after surgery than the group without induced habitual seizures [M (Q₁, Q₃): 0.17 (0, 4.00) times/month vs. 5.00 (2.50, 10.50) times/month, P=0.022]. Compared with those before surgery, the frequency of epileptic seizures in both groups decreased 3 months after surgery (both P<0.05).

The short-term effective rate of SEEG-guided RFTC in the treatment of mesial temporal lobe epilepsy is higher, and the effect is better in patients with habitual seizures induced by preoperative electrical stimulation. However, as time goes by, the effective rate decreases, and patients who relapse and need anterior temporal lobectomy can still achieve good therapeutic effect.

To investigate the reasons for the recurrence or ineffectiveness after microvascular decompression (MVD) for primary hemifacial spasm (HFS), as well as the strategies and efficacy of reoperation.

A retrospective analysis was conducted on the clinical data of 55 patients with recurrent or ineffective HFS after MVD, treated by the same surgeon in the Department of Neurosurgery at the China-Japan Friendship Hospital from February 2023 to April 2024. All patients underwent reoperation. Based on intraoperative findings, the reasons for recurrence or ineffectiveness were categorized into 3 types: Type Ⅰ involved severe adhesion between the original padding and the facial nerve and its root exit zone (REZ); Type Ⅱ resulted from the omission of vessels (mainly anterior inferior cerebellar artery and/or posterior inferior cerebellar artery) during the first surgery; and Type Ⅲ occurred when offending vessels were not completely and effectively decompressed, meaning that part of the offending vessels continued to compress the REZ and/or facial nerve. Corresponding reoperation strategies were employed for different types of reasons. The Cohen-Albert scoring system was used to assess the degree of hemifacial spasm relief postoperatively. All patients underwent clinical follow-up, and the surgical efficacy and complications were documented.

Among the 55 patients, 28 experienced recurrence, and 27 showed ineffectiveness after the initial MVD. Among the 28 recurrent cases, 18 were Type Ⅰ (64.3%), 7 were Type Ⅱ (25.0%), and 3 were Type Ⅲ (10.7%). Among the 27 ineffective cases, there was 21 cases of Type Ⅱ (77.8%), and 1(11.1%) of Type Ⅰ and 1(11.1%) of Type Ⅲ. Of the 28 missed offending vessels, 14 (50.0%) were anterior inferior cerebellar artery (AICA), 9(32.1%) were posterior inferior cerebellar artery (PICA), and 5 (17.9%) were vertebral artery complex. Among the 6 cases where offending vessels were not fully decompressed, 4 were AICA, and 2 were PICA. According to the different types, the corresponding reoperation treatment strategy was adopted. The 55 patients were followed up for 2-18 (mean: 7.2±2.1) months. At the last follow-up, the postoperative Cohen-Albert scores were 0 in 52 patients, 1 in 1 patient, and 2 in 2 patients. The cure rate was 94.5% (52/55), and the effective rate was 96.4% (53/55). During the follow-up, 9 patients (16.4%) experienced varying degrees of facial paralysis, and 6 patients (10.9%) had impaired hearing.

For patients with HFS experiencing recurrence or ineffectiveness after MVD, categorizing the causes based on intraoperative findings and employing targeted reoperation strategies for different types are effective and safe for treating such patients.

To elucidate the important anatomical structures involved in the surgical approach of internal jugular vein decompression through microscopic anatomy research, to clarify the spatial relationship between the transverse process of the atlas vertebra (C₁) and surrounding structures, and to provide anatomical evidence for performing internal jugular vein decompression surgery for the treatment of pulsatile tinnitus.

Three adult cadaveric head specimens (6 sides in total) were selected. Under the surgical microscope, the surrounding structures were dissected and microscopically observed with the transverse process of the atlas vertebra as the central reference point to determine the morphology and relationships of the surrounding anatomical structures.

The study revealed the clear exposure of the sternocleidomastoid muscle, posterior belly of the digastric muscle, and identification of the internal carotid artery, internal jugular vein, and accessory nerve of the upper neck using the transverse process of the atlas vertebra as a landmark. The exposure of the lateral skull base and mastoid process showed relatively fixed anatomical relationships between the transverse process of the atlas vertebra and surrounding muscles, bones, vessels, and nerves.

The transverse process of the atlas vertebra can serve as an important anatomical landmark in internal jugular vein decompression surgery. Familiarity with and understanding of the relationship between the transverse process of the atlas vertebra and surrounding structures can assist clinicians in accurate identification and protection of surrounding vital tissue structures during surgery.

To explore the specific killing effect of human peripheral blood-derived NK cells modified with Chimeric Antigen Receptor (CAR) targeting epidermal growth factor receptor type Ⅲ mutant (EGFRvⅢ ) on glioma cells.

Human peripheral blood-derived NK cells were obtained by Ficoll density gradient centrifugation and cultured in vitro. CAR-NK cells targeting EGFRvⅢ and U87-EGFRvⅢ stable cell lines were constructed by lentivirus infection. The experiments were divided into NK+ U87 group, NK+ U87-EGFRvⅢ group, CAR-NK+ U87 group and CAR-NK+ U87-EGFRvⅢ group. The killing effect of CAR-NK cells on glioma cells was evaluated by real-time unlabeled cell analysis (RTCA) and lactate dehydrogenase (LDH) release assay. At the same time, enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of tumor necrosis factor-α(TNF-α), interferon-γ (IFN-γ), granzyme B (GzmB) and perforin 1 (PRF1) in cell culture supernatant.

Flow cytometry analysis showed that the purity of human peripheral blood-derived NK cells was 97.6%, and the survival rate was 98.2%. The second generation of CAR molecules targeting EGFRvⅢ was successfully constructed, and CAR-NK cells targeting EGFRvⅢ were successfully obtained. Flow cytometry analysis showed that the positive cell rate was 69.6 %. RTCA results showed that the growth curve of target cells increased with time, and the proliferation rate of U87 cells overexpressing EGFRvⅢ was higher than that of U87 cells. After adding effector cells, the cell index showed a downward trend. At the same effector-target ratio (E ∶T), the cell index of CAR-NK+ U87-EGFRvⅢ group decreased faster than that of NK+ U87-EGFRvⅢ group, and faster than that of CAR-NK+ U87 group. LDH release assay further demonstrated that the cleavage rate of target cells gradually increased with the increase of effector-target ratio (F_{NK+ U87}=700.61, F_{CAR-NK+ U87}=2 063.97, F_{NK+ U87-EGFRvⅢ}=5 707.00, F_{CAR-NK+ U87-EGFRvⅢ}=28 858.57, all P<0.05). At E ∶T=2 ∶1 and E ∶T=3 ∶1, the cell lysis rates of NK+ U87-EGFRvⅢ group and CAR-NK+ U87 group were lower than that of CAR-NK+ U87-EGFRvⅢ group (all P<0.05). In addition, ELISA results showed that the secretion of TNF-α, IFN-γ, GzmB and PFR1 increased with the increase of effect-target ratio in the same group (all P<0.05); under the same effect-target ratio, except at E ∶T=1 ∶1, there was no significant difference in GzmB secretion between CAR-NK+ U87-EGFRv Ⅲ group and CAR-NK+ U87 group (P>0.05); the secretion of TNF-α, IFN-γ, GzmB and PFR1 in CAR-NK+ U87-EGFRv Ⅲ group increased compared with NK+ U87-EGFRv Ⅲ group and CAR-NK+ U87 group respectively (all P<0.05).

CAR-NK cells targeting EGFRvⅢ have a strong killing effect on glioma cells with positive expression of EGFRvⅢ, and their anti-tumor ability is better than that of NK cells.

Suprasellar arachnoid cysts presenting as bobblehead puppet syndrome are rare. The Department of Neurosurgery of Pediatric Hospital affiliated to Fudan University treated one child with this disease in October 2019 and March 2021, respectively. Both children were male, aged 13 and 15 months, respectively; The clinical manifestations were involuntary nodding with enlarged head circumference. One case of premature infant had developmental delay without intracranial hypertension. Two children underwent neuroendoscopic ventricular fenestration of suprasellar cistern arachnoid cyst plus third ventriculostomy. The involuntary nodding movement of 2 children after operation was significantly improved compared with the previous. One child was subjected to ventriculo-peritoneal shunt because hydrocephalus did not improve significantly and affected development. Two children were followed up for 31 to 38 months, and no recurrence of nodding symptom was observed.

Hemangioblastoma is a common vascular tumor of the central nervous system, while hemangioblastoma occurring in the lateral ventricle is relatively rare. Including this case, only 15 cases have been retrieved worldwide at present. This paper reports a patient with intraventricular hemangioblastoma with solid temporal horn occupation of the lateral ventricle as main manifestation. Intraoperative pathology was misdiagnosed as glioma, but postoperative diagnosis was confirmed by histopathology. Postoperative MRI confirmed complete resection of the tumor, and no new lesions were found on MRI 3 years after operation.

Carotid artery dissection (CAD) is a rare arterial vascular injury that often leads to ischemic stroke. If the diagnosis and treatment are not timely, it can cause serious consequences and even death. The accurate diagnosis and treatment of CAD is a difficult point in clinical practice. At present, the literature on clinical diagnosis and treatment of CAD at home and abroad is mostly case reports or series case studies, and there are few reports of large cases. As a result, the industry still lacks systematic understanding of the standardized diagnosis and treatment of CAD, and there are many problems such as clinical misdiagnosis or misdiagnosis and improper treatment methods. Therefore, this article reviews the clinical characteristics, diagnosis and treatment of CAD, so as to provide help for the clinical diagnosis and treatment of CAD.

Vertebral artery stenosis is an important factor leading to posterior circulation ischemic stroke. Patients with symptomatic vertebral artery stenosis have a 30% risk of posterior circulation ischemic stroke after 5 years, and the V1 segment at the beginning of the vertebral artery is more likely to form stenosis than other segments. Relevant guidelines suggest surgical and endovascular treatment for posterior circulation ischemia caused by symptomatic vertebral artery stenosis. At present, endovascular treatment is more inclined, and surgical treatment is less concerned and less selected. This article reviews the progress of clinical treatment of vertebral artery stenosis, especially V1 segment stenosis, in order to provide help for the clinical treatment of this disease.