Volume 40 · Issue 10 · 2024

The long-term harm of minor craniocerebral injury (mTBI) is often underestimated by clinicians. With the progress of diagnostic technology, the diagnosis and treatment of mTBI has been paid more and more attention. It is very important to comprehensively understand the pathogenesis and diagnosis and treatment strategies of mTBI. New technologies such as MRI examination of special sequences, serum biomarkers, neuroelectrophysiological examination, machine learning and artificial intelligence are playing an increasingly important role in the diagnosis of mTBI. In terms of treatment, symptom-oriented individualized rehabilitation programs have gradually become the mainstream of mTBI treatment.

To investigate the clinical efficacy of external carotid artery (ECA)-radial artery (RA)-middle cerebral artery (MCA) M2 segment bypass combined with aneurysm isolation surgery in patients with large/giant internal carotid artery aneurysms.

This retrospective single-center study enrolled 8 patients diagnosed with large/giant internal carotid artery aneurysms(10 cases of aneurysms in total and 2 cases of tandem aneurysms) who underwent ECA-RA-M2 bypass combined with aneurysm isolation surgery at the Department of Neurosurgery, Tianjin Huanhu Hospital between January 2016 and June 2021. Of the 8 patients, 2 were ruptured aneurysms. Preoperative evaluation confirmed positivity in the balloon occlusion test (BOT) and/or stage Ⅱ2 brain perfusion weighted imaging (PWI). Immediate postoperative embolization degree was assessed using the O′Kelly-Marotta (OKM) grading system. Intraoperative and postoperative complications were documented. Clinical symptoms were observed and outcomes were evaluated using the modified Rankin Scale (mRS) and Karnofsky Performance Status (KPS) scale.

Among the 8 patients, the postoperative complete occlusion/OKM grading of D1 and near-total occlusion/OKM C1 was observed in 6 patients and 1 patient, respectively. During the perioperative period, 2 patients experienced ischemic stroke. The follow-up duration [M(Q₁, Q₃)] of 8 patients was 69.9 (55.0, 85.3) months. By the end of the follow-up period, 6/8 of patients exhibited relief or recovery from preoperative clinical symptoms. Ischemic stroke occurred in 1 patient. At the last follow-up, the mRS score was 0 in 5 patients, 1 in 2, 4 in 1. There was no statistically significant difference in mRS scores before and after surgery (Z=-1.19, P=0.236). The KPS scores of 8 patients were 92.5±13.9 points. Imaging follow-up time [M(Q₁, Q₃)] was 35.8 (5.8, 68.8) months, with aneurysm shrinkage demonstrated in 1 patient and complete or near-total occlusion in the remaining 7 patients.

ECA-RA-M2 bypass combined with aneurysm isolation remains an essential therapeutic modality for addressing large/giant internal carotid artery aneurysms characterized by inadequate blood flow compensation.

To construct a predictive model for the risk of posterior communicating artery aneurysm rupture from a morphological perspective and to evaluate its effectiveness.

A retrospective analysis was conducted on the clinical data of 177 patients with posterior communicating artery aneurysms (192 cases) admitted to the Department of Neurosurgery, Linyi People′s Hospital from March 2022 to December 2023. UKnow^® intracranial aneurysm surgical planning software based on artificial intelligence algorithms was utilized, 17 morphological parameters (length diameter, width, height, longest diameter, ratio of length to width, aneurysm volume, aneurysm neck area, aneurysm neck diameter, ratio of transverse diameter to aneurysm neck diameter, aneurysm angle, fluctuation index, size ratio, non-spherical index, aspect ratio, ratio of aneurysm volume to aneurysm neck area, transverse diameter, inflow angle) were accurately measured. According to whether the aneurysm ruptured or not, they were divided into ruptured group (108 cases) and unruptured group (84 cases). Univariate and multivariate logistic regression analyses were used to compare the clinical data and morphological characteristics of two groups of aneurysms, and construct a rupture risk prediction model. R language was used to draw a column chart of the prediction model and its receiver operating characteristic (ROC) curve. The decision curve analysis (DCA) method was used to evaluate the clinical efficacy of the prediction model, and calibration curve was used to evaluate the accuracy of the prediction model.

The results of univariate logistic regression analysis showed that history of alcohol consumption, larger length diameter, height, longest diameter, ratio of length to width, ratio of transverse diameter to aneurysm neck diameter, inflow angle, aneurysm angle, fluctuation index, size ratio, aspect ratio, ratio of aneurysm volume to aneurysm neck area, as well as the presence of ascus in aneurysm body and more aneurysm body ascus were all positive influencing factors for aneurysm rupture (all P<0.05). Multiple logistic regression analysis showed that increased ratio of length to width (OR=238.26, 95%CI: 6.48-8 761.90, P=0.003), increased inflow angle (OR=1.08, 95%CI: 1.04-1.11, P<0.001), increased aspect ratio (OR=8.44, 95%CI: 1.17-61.19, P=0.035), and the presence of ascus in aneurysm body (OR=42.39, 95%CI: 8.68-206.92, P<0.001) were independent risk factors for aneurysm rupture. The area under the ROC curve of the prediction model was 0.97. According to the DCA curve and calibration curve, the model had clinical practical benefits and good accuracy.

The rupture risk prediction model based on the ratio of length to width, inflow angle, aspect ratio and the presence of ascus in aneurysm body has good diagnostic efficacy, and its nomogram can evaluate the rupture risk of unruptured posterior communicating artery aneurysms more accurately and conveniently.

To investigate the efficacy of hybrid operation for intracranial unruptured arteriovenous malformations (AVM) with epilepsy as the first symptom in children.

A retrospective analysis was conducted on the clinical data of 14 children with intracranial unruptured AVM with epilepsy as the first symptom who were admitted to the Neurosurgery Department of Children′s Hospital Affiliated to Nanjing Medical University from January 2018 to September 2022. There were 11 cases of normal and 3 cases of abnormal electroencephalogram (EEG) during the interictal phase. AVM was located in the frontal lobe in 7 cases, temporal lobe in 5 cases, and parietal and occipital lobes in 1 case each, all of which were dense. All 14 children were treated with hybrid surgery [cerebral digital subtraction angiography (DSA) and craniotomy surgery to remove AVM]. For 3 cases with abnormal EEG, cortical EEG monitoring was performed during surgery, and radiofrequency thermocoagulation or resection of the epileptic focus was performed. The surgical complications were documented. DSA was performed 6 to 12 months after surgery, and annual imaging follow-up was performed. The neurological function was evaluated using the modified Rankin scale score (mRS), and the score of 0-1 in mRS was considered normal. The effectiveness of seizure control was evaluated using Engel grading system.

All 14 cases underwent complete resection of the AVM. Among the 11 cases with normal preoperative EEG, 2 cases were found to have deposition of hemosiderin and glial hyperplasia adjacent to AVM during surgery, and were removed; Among the 3 cases of preoperative abnormal EEG, 2 cases were treated with effective thermocoagulation, and 1 case was treated with lesion cortical resection due to ineffective thermocoagulation. One patient developed hemiplegia and aphasia after surgery, and returned to normal two weeks later. Fourteen patients were followed up for 12-48 months (median: 28 months). As of the last follow-up, there was no recurrence of AVM, and the neurological function of all 14 patients was normal. There were 13 cases with Engel grade Ⅰa and 1 case with grade Ⅱ.

Preliminary observations have shown that using hybrid surgery to treat unruptured intracranial AVM in children with epilepsy as the initial symptom has a high cure rate and good safety.

To initially explore the safety and effectiveness of a one-staged hybrid surgical platform in the treatment of acute hemorrhagic high-flow cerebral vascular malformations (HFVMs).

Patients with acute hemorrhagic HFVMs who were consecutively enrolled from January 2019 to April 2024 were screened from a prospective, multi-center surgical cohort of hybrid surgical treatment of cerebral vascular malformations (NCT03209804). All patients underwent diagnostic intraoperative digital subtraction angiography (DSA) and different modes of surgical treatment on a hybrid surgical platform. The patients′ functional outcomes (assessed by the modified Rankin scale score) were analyzed to clarify the safety and effectiveness of the hybrid surgical platform in the treatment of acute hemorrhagic HFVMs.

A total of 56 patients with acute hemorrhagic HFVMs were included, including 47 patients (83.9%) with intracranial arteriovenous malformation rupture and bleeding, 8 patients (14.3%) with dural arteriovenous fistula, and 1 patient (1.8%) with pial arteriovenous fistula. Among the 56 patients, 33 patients underwent arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation, 15 patients underwent endovascular embolization-assisted arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation, 6 patients underwent curative embolization of arteriovenous malformation or arteriovenous fistula, and 2 cases were treated with curative embolization of arteriovenous malformation or arteriovenous fistula plus minimally invasive hematoma evacuation. The all-cause mortality rate of patients within 1 month after surgery was 3.6% (2/56). The rates of patients with severe neurological dysfunction (modified Rankin score >3 points) at discharge, 3 months after surgery, and 6 months after surgery were 46.4% (26/56), 16.1% (9/56), and 8.9% (5/56), respectively.

The one-staged diagnosis and treatment model based on the hybrid surgical platform can be safely and effectively used to treat acute hemorrhagic HFVMs.

To explore the related factors affecting 2-year postoperative survival and prognosis of young patients with aneurysmal subarachnoid hemorrhage (aSAH).

A retrospective analysis was conducted on the clinical data of 177 young patients (age ≤40 years) with aSAH treated in the Department of Neurosurgery at 12 hospitals including Tianjin Medical University General Hospital from January 2017 to December 2020. According to the treatment methods, they were divided into two groups: aneurysm surgical clipping group (SC group, 78 cases) and endovascular coiling group (EC group, 99 cases). The clinical data of the two groups of patients were collected and compared, and matched according to a 1 ∶1 propensity score. The differences in baseline data, complications during hospitalization, and 2-year outcome between the two groups of patients after matching were analyzed. A modified Rankin scale sore (mRS) of 0-2 was defined as a good prognosis. Univariate Cox regression analysis was performed on the matched young aSAH patients. Variables with P<0.05 in the univariate analysis, gender, and age were included in the multivariate Cox regression model for 2-year survival prognosis analysis. Univariate and multivariate logistic regression analyses were used for analyze the risk factors affecting the 2-year prognosis of young patients with aSAH. The Kaplan-Meier method was used to calculate the 2-year survival rate of the two groups of patients, and the log-rank test was used to compare the difference in survival rates between the two groups.

After the patients in the SC group and the EC group were matched according to the 1 ∶1 propensity score (a total of 54 pairs were successfully matched), there were no statistically significant differences in the baseline data of the two groups of patients (including age, gender, Hunt-Hess classification and follow-up time), mortality rate, mRS at discharge and 2 years post surgery, or complications during hospitalization (all P>0.05). However, the length of hospitalization of patients in the SC group was longer than that of the EC group, and the difference was statistically significant (P=0.001). The results of univariate Cox regression analysis showed that Hunt-Hess grade Ⅳ to Ⅴ, cerebral ischemia, stress ulcer bleeding, abnormal liver function, urinary tract infection, and anemia were risk factors affecting the 2-year survival of young aSAH patients (all P<0.05); multivariate Cox regression analysis results showed that Hunt-Hess grade Ⅳ to Ⅴ was a risk factor affecting the 2-year survival of young aSAH patients (HR=13.61, 95%CI: 3.11-59.63, P=0.001). The results of univariate logistic regression analysis showed that Hunt-Hess grade Ⅳ to Ⅴ, postoperative cerebral ischemia and pneumonia were factors affecting the 2-year poor prognosis of young aSAH patients (all P<0.05). The results of multivariate logistic regression analysis showed that Hunt-Hess grade Ⅳ to Ⅴ (OR=8.47, 95%CI: 1.75-41.05, P=0.008) and postoperative pneumonia (OR=7.54, 95%CI: 1.36-41.96, P=0.021) were independent risk factors affecting the 2-year poor prognosis of young patients with aSAH. The log-rank test results showed that there was no statistically significant difference in the 2-year survival rate between the SC group and the EC group (92.6% vs. 85.2%, P=0.350).

There is no difference in the 2-year postoperative survival and prognosis of young aSAH patients treated with craniotomy clipping or interventional embolization. The survival and prognosis of young aSAH patients with preoperative Hunt-Hess grade Ⅳ to Ⅴ are often poor, and patients with postoperative pneumonia need to be actively managed.

To investigate the incidence of postoperative complications in patients with unstable moyamoya disease undergoing combined revascularization surgery and to analyze the associated risk factors.

A retrospective study was performed on 1 142 moyamoya disease patients who underwent combined revascularization surgery at the Department of Neurosurgery, Zhengzhou University People′s Hospital (Henan Provincial People′s Hospital) between January 2018 and December 2022. According to the inclusion criteria, the patients were divided into conventional moyamoya disease group and unstable moyamoya disease group, and the incidence of complications in the early postoperative period (within 14 days) of the two groups of patients was compared and analyzed. Patients with unstable moyamoya disease were further divided into postoperative complications group and no-complication group. The differences in clinical data between the two groups were compared. Multivariate logistic regression analysis was used to analyze the risk factors affecting early postoperative complications in patients with unstable moyamoya disease. P<0.05 was considered as a statistically significant difference.

Among the 1 142 patients, 1 091 were in the conventional moyamoya disease group and 51 were in the unstable moyamoya disease group. The overall incidence rate of reversible ischemic neurological dysfunction (RIND), cerebral infarction, cerebral hemorrhage and epileptic seizure in the postoperative unstable moyamoya disease group was 41.2% (21 cases), which was higher than the 10.3% in the conventional moyamoya disease group (112 cases) (P<0.001), among which the difference in the incidence of cerebral infarction was the most significant [29.4% (15/51) vs. 1.0% (11/1 091), P<0.001]. Among patients with unstable moyamoya disease, compared with the postoperative no-complication group (30 cases), the complication group (21 cases) had higher proportions of patients with transient ischemic attack (TIA) as the initial preoperative symptom [57.1% (12/21) vs. 23.3% (7/30)], with the degree of stenosis of the vessel on the stenotic side ≤50% [47.6% (10/21) vs. 10.0% (3/30)], and with the occlusion test on the surgical side [90.5% (19/21) vs. 50.0% (15/30)] (all P<0.05). Multivariate logistic regression analysis showed that TIA as the first preoperative symptoms TIA (OR=7.45, 95%CI: 1.25-44.50, P=0.028), degree of stenosis of the vessel on the stenotic side ≤50% (OR=14.88, 95%CI: 1.56-142.07, P=0.019), and occlusion on the stenotic side (OR=44.87, 95%CI: 3.16-636.88, P=0.005) were risk factors for complications after revascularization in patients with moyamoya disease.

Patients with unstable moyamoya disease are at high risk for perioperative complications following combined revascularization surgery. Key risk factors include vascular stenosis ≤50% on the stenotic side, occlusion on the operative side and initial symptoms of TIA.

To investigate the safety and efficacy of flow diverter (FD) devices in the treatment of intracranial aneurysms complicated with moderate to severe stenosis of adjacent arteries.

A retrospective analysis was conducted on the clinical data of 40 patients (with 42 aneurysms) with cerebral aneurysms complicated with moderate to severe stenosis of adjacent arteries at the Department of Neurointerventional Radiology, the First Affiliated Hospital of Zhengzhou University from July 2019 to November 2023. All patients underwent FD placement and percutaneous transluminal angioplasty with balloon dilation was performed on the stenotic adjacent arteries. The immediate embolization of the aneurysms was assessed using the O′Kelly-Marotta (OKM) grading scale, and surgery-related complications were documented. Regular telephone follow-ups were conducted to evaluate the improvement of clinical symptoms using the modified Rankin Scale (mRS). Imaging follow-up was performed to assess aneurysm embolization using the OKM grading scale and to check for the presence of in-stent stenosis (ISS).

A total of 42 aneurysms were treated with 41 FDs, with no procedure-related complications. The immediate OKM grading showed 8 aneurysms (19.0%) of Grade A, 23 (54.8%) of Grade B, 8 (19.0%) of Grade C, and 3 (7.2%) of Grade D. Perioperative complications occurred in 4 patients (10.0%), including 1 death, 1 case of cerebral hemorrhage, and 2 cases of cerebral infarction. Follow-up was conducted for 39 patients (97.5%) at 3 months after discharge. The patients who experienced perioperative complications of cerebral hemorrhage and cerebral infarction had an mRS score of 0. Two patients with previous cerebral infarction had an mRS score of 1, while the remaining 34 patients had an mRS score of 0. At the 6-month follow-up, 32 patients (80.0%) were evaluated. The mRS score of 2 patients with previous cerebral infarction remained at 1, and the remaining 30 patients had an mRS score of 0. Radiological follow-up was completed for 32 patients (with 34 aneurysms) with the follow-up duration [M(Q₁, Q₃)] of 6 (6, 10) months. The OKM grading showed 3 aneurysms (8.8%) of Grade A, 5 (14.7%) of Grade B, 4 (11.8%) of Grade C, and 22 (64.7%) of Grade D. Mild in-stent stenosis (ISS) was observed in 8 cases (25.0%), and severe ISS was noted in 8 cases (25.0%).

Preliminary observations indicate that using FD devices to treat intracranial aneurysms with moderate to severe stenosis of adjacent arteries is effective and has an acceptable safety profile. However, the incidence of ISS and ischemic complications during the follow-up period warrants further investigation.

To explore the effect of multimodal neuronavigation in thalamic glioma surgery.

A retrospective analysis was conducted on the clinical data of 53 patients with thalamic glioma admitted to the Department of Neurosurgery, the First Affiliated Hospital of Soochow University from January 2015 to January 2022. Among them, 11 patients underwent routine operations (traditional surgical group), 10 patients were treated with multimodal neuronavigation combined with intraoperative electrophysiological monitoring (combination technique group), and on the basis of the combined technology group, nuclear reconstruction technology were used in 32 cases to locate thalamic nuclei and brain functional areas before surgery (combination technique + preoperative positioning group). The differences in preoperative baseline condition, total tumor resection rate, operation time, new neurological deficits after surgery and the improvement of Karnofsky functional status score (KPS) at discharge were analyzed among the three groups.

The total tumor resection rate of the traditional surgical group, the combination technique group and the combination technique + preoperative positioning group were 3/11, 9/10 and 29/32 (90.6%) respectively. The proportion of patients with new neurological deficits after surgery in the traditional surgical group, the combination technique group and the combination technique + preoperative positioning group were 6/11, 1/10 and 5/32 (15.6%) respectively. The proportion of patients with increased KPS score at discharge in the traditional surgical group, the combination technique group and the combination technique + preoperative positioning group were 1/11, 6/10 and 18/32 (56.3%) respectively. Compared with the traditional surgical group, both combination technique group and the combination technique + preoperative positioning group had significant differences in the above indicators (all P<0.01). There were no statistically significant difference in the above indicators between the combination technique group and the combination technique + preoperative positioning group (all P>0.05). There was no statistically significant difference in operation time among the three groups (P=0.930).

Using the multimodal neuronavigation in thalamic glioma surgery can improve the total tumor resection rate, reduce the neurological deficits and increase the KPS score after surgery.

To investigate the clinical efficacy of hybrid operating techniques in the treatment for spinal dural arteriovenous fistulas (SDAVF).

A retrospective analysis was conducted on the clinical data of 18 consecutive SDAVF patients treated with hybrid operation in the Neurosurgery Department of Shanxi Provincial People′s Hospital from May 2020 to March 2023. All patients underwent spinal cord angiography during operation to confirm the source of the supply artery, the location of the fistula and the extent of drainage venous. The fistulas at the beginning of drainage venous site were resected under microscope by bipolar electrocoagulation. After 6 months post surgery, imaging examinations were performed, and the efficacy was evaluated using the Modified Aminoff-Logue Scale (mALS) score. A score of 0 in mALS was considered as cured, a decrease of ≥ 3 points from the preoperative score was considered as improved, and a decrease of <3 points was considered as uncured.

All patients successfully underwent the surgery, and intraoperative angiography confirmed the complete disappearance of the fistula and abnormal drainage veins. None of the patients experienced any complications related to the surgery or spinal cord angiography. After 6 months, Spinal MRI examination confirmed the absence of residual or recurrent lesions in all patients; the mALS score was 2.06 ± 1.98, which showed significant improvement compared with the preoperative score of 5.56 ± 2.62 (P<0.01). Out of all cases, 6 were cured, 11 showed improvement, and 1 was unhealed. Among the 7 cases with a disease course of less than 3 months, 5 cases were cured and 2 cases showed improvement; among the 6 cases with a disease course of 3 to 12 months, 1 case was cured and 5 cases showed improvement; among the 5 cases with a disease course of more than 12 months, 4 cases showed improvement and 1 case was not cured.

Hybrid operating techniques for SDAVF can enhance the cure rate of lesions and decrease complications. Further research is needed to explore the connection between the prognosis and disease course.

To investigate the therapeutic efficacy of facial nerve neurolysis in treating spastic facial paralysis sequelae after Bell′s palsy, and to identify factors that may influence treatment outcomes.

A retrospective analysis was conducted on the clinical data of 32 patients with spastic facial paralysis sequelae following Bell′s palsy, who underwent facial nerve neurolysis at the Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to January 2022. Preoperative House-Brackmann (H-B) grading showed 26 cases with grade Ⅱ and 6 cases with grade Ⅲ. There were 8 patients having a disease course >1 year and 24 patients with the disease course ≤1 year. The safety of the surgery was assessed by evaluating whether the severity of facial paralysis worsened one year postoperatively using the HB grading system. The overall alleviation of spastic facial paralysis sequelae was evaluated using a self-assessment scale, with a score of <5 indicating no alleviation (non-alleviation group) and a score of ≥5 indicating effective alleviation (effective alleviation group). Factors potentially influencing the overall alleviation were analyzed. The effectiveness of symptom alleviation for six major symptoms, including facial tightness, facial stiffness, synkinesis, facial muscle twitching, difficulty in opening eyes, and smaller eye fissures was assessed using a self-assessment scale respectively, and the effective alleviation rates were also calculated.

All 32 surgeries were successfully completed. Upon discharge, 23 patients (71.9%) were classified as HB grade Ⅱ and 9 patients (28.1%) as HB grade Ⅲ. Postoperative complications included numbness in the skin of the postauricular region and auricle in 6 patients (18.8%) and mild pain in the postauricular skin in 5 patients (15.6%). One year postoperatively, all 32 patients were followed up clinically; 28 patients (87.5%) were classified as H-B grade Ⅱ and 4 patients (12.5%) as HB grade Ⅲ; symptoms of numbness or mild pain in the ear region disappeared in all affected patients. Spastic facial paralysis sequelae were effectively alleviated in 26 patients (81.3%), while no alleviation was observed in 6 patients (18.7%). No statistically significant differences were found between the effective alleviation group and non-alleviation group in the gender, age, surgical side, and preoperative facial paralysis severity (all P>0.05). However, the difference in disease course was statistically significant (P=0.023). The effective alleviation rates for the six major symptoms of spastic facial paralysis sequelae were, in the order mentioned above, 93.8% (30/32), 90.6% (29/32), 81.3% (26/32), 75.0% (24/32), 50.0% (16/32), and 46.9% (15/32) respectively.

Preliminary observations suggest that facial nerve neurolysis can effectively alleviate the symptoms of spastic facial paralysis sequelae, with early surgical intervention potentially being key to improving surgical outcomes.

To investigate the efficacy of microsurgical decompression of peripheral nerves in the treatment of lower limb dialysis-associated peripheral neuropathy (DRPN) in the lower limbs.

The clinical data of 21 patients with DRPN in their lower limbs, who were admitted to the Department of Neurosurgery of China-Japan Friendship Hospital from January 2018 to December 2022, were retrospectively analyzed. Microsurgical decompression was performed on the common peroneal nerve (CPN), posterior tibial nerve (PTN) and its three branches in all 21 patients with a total of 42 affected limbs. All patients were followed up after discharge, which included recording their symptom relief and review of EMG (electromyography) to assess the efficacy.

All 21 cases underwent successful operations. The mean follow-up time for these patients was 22.5±9.9 months (range: 12 to 48 months). Up to the last follow-up, the results of EMG review showed that compared with preoperative values, there was a significant increase of CPN in the sensory nerve conduction velocity (42.2±3.7 m/s vs. 33.2±4.1 m/s) and action potential amplitude (9.2±1.5 mV vs. 5.8±1.1 mV), as well as the motor nerve conduction velocity (44.2±3.1 m/s vs. 37.0±3.9 m/s) and action potential amplitude (9.1±l.6 mV vs. 6.4±1.3 mV) (all P<0.05). PTN also exhibited an increase in the sensory nerve conduction velocity from (43.3±2.8 m/s vs. 34.1±4.5 m/s) and action potential amplitude (9.1±1.6 mV vs. 6.3±1.2 mV), as well as the motor nerve conduction velocity (43.0±3.2 m/s vs. 36.7±4.8 m/s) and action potential amplitude (8.7±1.7 mV vs. 6.8±1.3 mV) (all P<0.05). Up to the last follow-up, numbness on 36 sides (85.7%) of the affected limb was relieved in 21 patients, pain symptoms on 42 sides (100.0%) were relieved, and motor function of the affected limb on 38 sides (90.5%) was relieved.

Microsurgical decompression of the peripheral nerve can effectively improve the nerve conduction velocity and action potential amplitude of lower limb NRPN pationts, and alleviate their limb symptoms. So it is an effective method for the treatment of DRPN in the lower limbs.

To develop a predictive model for surgical treatment of primary trigeminal neuralgia (PTN) based on machine learning support vector machine algorithm (SVM) and to verify its effectiveness.

Two datasets of PTN patients admitted consecutively to the Neurosurgery Department of the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Dataset 1 retrospectively collected 167 patients from June 2022 to February 2023, and Dataset 2 prospectively collected 41 patients from March to June 2023. We randomly divided dataset 1 into a training set (125 cases) and a testing set (42 cases) in a 3 ∶1 ratio. Surgical methods, including microvascular decompression (MVD), radiofrequency thermocoagulation (RFTC) and percutaneous ballon compression (PBC), were used as the dependent variables, Lasso regression analysis was performed to screen feature variables in training set, which were incorporated into machine learning to construct a predictive model for surgical treatment methods. We used the testing set to validate and evaluate the model, and used dataset 2 (validation set) for external validation. The receiver operating characteristic (ROC) curve of the model was drawn and the area under the curve (AUC) was calculated to evaluate its predictive performance on different datasets. The visual analog scale (VAS) was used to evaluate the pain level of PTN patients before and one month after surgery, and the difference in VAS between dataset 1 and dataset 2 patients was compared. Meanwhile, we documented the incidence of surgical related adverse reactions or complications in patients from two dataset.

The Lasso regression analysis showed that the feature variables with non-zero regression coefficients were PBC surgery history, age, magnetic resonance tomography angiography (MRTA) results, MVD surgery history, other restrictive diseases, pain distribution, disease duration, and RFTC surgery history. The overall accuracy of the prediction model in the training set, testing set, and validation set was 73.6%, 69.0%, and 73.2%, respectively. The AUC (macro/micro) under the ROC curve was 0.89/0.89, 0.80/0.81, and 0.85/0.85, respectively. There was no statistically significant difference (P>0.05) in features such as age, disease duration, or surgical methods between patients in dataset 1 and dataset 2. There was no statistically significant difference in the VAS score either from before surgery or 1 month after surgery between dataset 1 and dataset 2 (both P>0.05). Compared with preoperative data, the VAS scores of dataset 1 and dataset 2 decreased one month after surgery, and the differences were statistically significant (both P<0.001). Two patients in dataset 1 developed subcutaneous fluid accumulation after MVD surgery, and one patient in dataset 2 had poor wound healing after MVD surgery. There was no statistically significant difference in the incidence of complications between the two datasets [1.2%(2/167) vs. 2.4%(1/41), P=0.484].

The multiclass machine learning prediction model based on SVM algorithm has good performance and can guide clinicians to develop personalized surgical treatment plans. The treatment is effective and does not seem to increase the incidence of complications.

To summarize the clinical characteristics of elderly patients hospitalized with traumatic brain injury (TBI) in Xinjiang, and to explore the risk factors affecting patients′ mortality.

A retrospective, multicenter study was conducted on the data of the clinical characteristics of elderly (≥65 years old) TBI inpatients in 28 hospitals of different levels in Xinjiang region from January 2021 to December 2021. We analyzed the clinical characteristics of elderly TBI inpatients in Xinjiang. Univariate analysis and multifactorial logistic regression analysis were used to explore the factors that might affect the mortality of patients.

A total of 538 elderly TBI patients were included. The ratio of male to female was 2.02 ∶1.00 and the median age [M(Q₁, Q₃)] was 73 (68, 80) years old. Falling (59.85%, 322/538) was the leading cause of injury in elder adults with TBI, followed by traffic injuries (30.11%, 162/538). Subarachnoid hemorrhage (49.81%, 268/538) was the most frequent type of intracranial injury, and 45.35% (244/538) of the patients had a combined extracranial injury. 14.68% (79/538) of the patients exhibited midline shift. 20.26% (109/538) of the patients were admitted to the intensive care unit. Conservative treatment was given to 78.81% (424/538) of the patients. The patient′ mortality rate was 6.69% (36/538). The results of univariate analysis showed that Glasgow Coma Score, the occurrence of midline shift, the occurrence of emergency tracheal intubation, place of admission, and whether or not surgery was performed were associated with the patient′ mortality (all P<0.05). The results of multifactorial logistic analysis showed that low Glasgow Coma Score on admission (OR=6.99, 95%CI: 1.80-27.13), midline shift (OR=4.95, 95%CI: 1.97-12.46), emergency endotracheal intubation (OR=5.92, 95%CI: 2.12-16.53), and being admitted to the intensive care unit (OR=6.41, 95%CI: 1.91-21.58), and performing surgery (OR=4.62, 95%CI: 1.54-13.84) were all independent risk factors for death in elderly TBI patients(all P<0.05).

Elderly TBI patients in Xinjiang region are predominantly males, the main cause of injury is falling on the ground, and the overall prognosis is good. Patients with a low Glasgow Coma Score on admission, midline shift, emergency tracheal intubation, immediate admission to the intensive care unit, and surgery seem to be at higher risk of death.

To investigate the effects of METTL16 on the proliferation and invasion of glioblastoma (GBM) cells and to reveal the underlying molecular mechanisms.

Human glioblastoma cell lines U87 and U251 were cultured in vitro, and METTL16 stable overexpression cell lines were obtained by transfection of METTL16 overexpression vector. According to the cell intervention method, the experimental cell lines were divided into negative control (NC) group, overexpression negative control (OE-NC) group and METTL16 overexpression (OE-METTL16) group. METTL16 gene overexpression was detected by the Western blot (WB) and quantitative PCR (qPCR) assay. The effect of overexpression of METTL16 on the proliferation of experimental cell lines was detected by CCK-8 assay. The effects of overexpression of METTL16 on migration and invasiveness of experimental cell lines were investigated by cell scratch and Transwell assay. The effect of METTL16 overexpression on apoptosis and cell cycle was detected by flow cytometry. WB assay was used to detect the effect of overexpression of METTL16 on the expression levels of the pyroptosis markers in the experimental cell lines.

WB and qPCR experiments showed that the experimental cell lines with METTL16 overexpression were successfully constructed. The results of CCK-8 experiment showed that compared with NC or OE-NC group, the cell proliferation capacity of OE-METTL16 group was significantly inhibited (both P < 0.05). Cell scratch and Transwell tests showed that both cell mobility and number of invaded cells in OE-METTL16 group were significantly lower than those in NC and OE-NC groups (both P < 0.05). Flow cytometry showed that compared with either NC or OE-NC group, the apoptosis rate of OE-METTL16 group was significantly increased (both P<0.01). In addition, the proportion of G2/M phase cells in the OE-METTL16 group increased compared with the NC or OE-NC group (both P<0.01); overexpression of METTL16 could induce cell cycle arrest in G2/M phase. WB assay showed that the expression levels of pyroptosis-related marker interleukin 1β, nuclear factor κB, myeloid differentiation factor 88, nucleotide-binding oligomerization domain-like receptor protein 3, gasdermin D (GSDMD) and cysteinyl aspartate specific proteinase-1 in OE-METTL16 group were all significantly increased compared with those in NC and OE-NC groups (both P < 0.05).

METTL16 gene can effectively inhibit the proliferation, invasion and migration of GBM cells by regulating GSDMD-mediated pyroptosis, which could provide new ideas and direction as a potential molecular target for GBM therapy.

In order to investigate the effect of occipital artery-vertebral artery V3 segment bypass grafting in the treatment of vertebral artery occlusion, the clinical data of 3 patients with vertebral artery occlusion who underwent occipital artery-vertebral artery V3 segment bypass grafting in the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from July 2021 to June 2022 were retrospectively reported. All three patients underwent digital subtraction angiography to confirm the patency of bypass vessels. There were no related complications after operation in all 3 patients. After 12-20 months follow-up, 1 patient had dizziness relieved significantly, and 2 patients had occasional dizziness without other symptoms of neurological deficit.

Histiocytic sarcoma is a rare but highly aggressive non-Langerhans histiocytic tumor derived from monocytes or macrophages. The disease occurs in all ages, but it is more common in adults. Primary histiocytic sarcoma of central nervous system is extremely rare, rarely reported at home and abroad, and has no specific imaging manifestations, which makes differential diagnosis difficult. The Department of Neurosurgery, First Medical Center, PLA General Hospital, admitted a patient with primary central nervous system histiocytic sarcoma in January 2021, who had a rapid course of disease, high malignancy, extremely poor prognosis and only survived for 6 months after surgery. This article summarizes and analyzes the clinical characteristics and the diagnosis and treatment process of this patient, in order to provide help for the diagnosis and treatment of this disease.

Variants of the middle cerebral artery (MCA) are rare, and those with multiple MCA variants are even rarer. In August 2023, the Department of Neurosurgery of Gaomi People's Hospital admitted a patient with 5 MCA (right accessory MCA, duplicate MCA, MCA, left accessory MCA, MCA) and acute occlusion of the right MCA main trunk. The effect of intravenous thrombolytic therapy was not obvious, so endovascular therapy was performed, and a NeuroformEZ stent was placed after balloon dilation. One month after surgery, angiography showed patency of the occluded vessels, and the modified Rankin scale score was 0.

At present, surgery is still the preferred treatment for pituitary growth hormone (GH) cell tumors. With the deepening of clinical research, some progress has been made in the research of perioperative diagnosis and treatment of this disease in recent years, mainly in precise diagnosis and risk assessment before operation, assessment of recurrent and ectopic tumors, endocrine and anesthesia management, development of intraoperative auxiliary technology and selection of surgical approach, etc. In addition, there are many new research achievements in the management of surgical complications, prediction and evaluation of postoperative efficacy, management of postoperative recurrent or residual tumors, and treatment of special populations. Therefore, this article reviews the progress of diagnosis and treatment of pituitary GH cell tumors in the perioperative period, in order to provide assistance for clinical formulation of individualized treatment plans.