Volume 40 · Issue 11 · 2024

Patients with facial nerve injury are prone to symptoms such as facial motor dysfunction, and in severe cases, facial muscle paralysis can be caused, which affects the quality of life of patients. Surgery is an important method for the treatment of facial paralysis, and choosing a reasonable surgical method is very important for the treatment effect of facial paralysis. Based on the clinical experience of our team, we now summarize the clinical evaluation points and surgical strategies of facial paralysis, aiming at standardizing the clinical treatment of facial paralysis and improving the diagnosis and treatment level of facial paralysis.

To preliminary explore the feasibility, safety and effectiveness of hybrid surgery [carotid endarterectomy (CEA) + immediate postoperative digital subtraction angiography (DSA) and endovascular treatment when necessary] in the treatment of symptomatic near-occlusion of carotid artery (NOCA).

The clinical data of patients with symptomatic NOCA who underwent hybrid surgery at the Department of Cerebrovascular Diseases, Henan Provincial People′s Hospital (People′s Hospital of Zhengzhou University) from June 2018 to August 2022 were retrospectively analyzed. A total of 41 patients (41 NOCA lesions) were included, 15 of which were combined with other severe stenosis or occlusive lesions of other cranial and neck large arteries. All patients underwent DSA through femoral artery puncture after CEA. If there was severe residual stenosis or occlusion, endovascular treatment was performed. Perioperative complications and postoperative vascular patency were observed. According to whether preoperative carotid arteries had complete collapse, the patients were divided into the complete collapse group (12 cases) and incomplete collapse group (29 cases). At 6 months after surgery, color Doppler ultrasound of carotid artery, head CTA or DSA examination was used to evaluate the patency of the carotid artery and compare the vascular patency and recovery of distal diameter in the complete collapse group and incomplete collapse group.

The carotid arteries of 41 patients were successfully recanalized. Immediate postoperative DSA showed severe vascular defects in 18 patients (43.9%), of whom 10 underwent endovascular treatment. Perioperative complications occurred in 7 patients (17.1%), which 1 patient experienced jugular vein bleeding during the operation, 1 patient died of pulmonary infection due to high perfusion bleeding after surgery; 1 patient developed acute hematoma in the neck after surgery; 1 patient suffered from poor postoperative incision healing; 1 patient suffered from postoperative angina pectoris; 2 patients suffered from obvious hyperperfusion headache but no intracranial hemorrhage after surgery; no permanent sequelae or symptomatic ischemic stroke occurred in any patient. Five patients with severe stenosis or occlusion of other major arteries in the head and neck underwent endovascular treatment at the same time, and no perioperative complications occurred. Subgroup analysis showed that there were no statistically significant differences in baseline data such as gender, age, and preoperative symptoms between the complete collapse group and the incomplete collapse group (all P>0.05). Compared with the incomplete collapse group, patients in the complete collapse group had a higher proportion of patients who underwent rescue endovascular treatment during surgery (7/12 vs. 3/29, P=0.004). A total of 39 patients (95.1%) received clinical follow-up, and the follow-up time [M (range)] was 15 (9-38) months. The last follow-up showed that no ischemic stroke symptoms occurred. A total of 23 patients (56.1%) received imaging follow-up, and the follow-up time [M (range)] was 7 (5-13) months. The last follow-up showed that there was no carotid artery re-occlusion or restenosis. In the complete collapse group 6 cases obtained CTA examination, the carotid artery diameter did not return to normal or close to normal. Ten patients in the incomplete collapse group obtained CTA or MRA examinations and 9 cases returned to normal.

The technical success rate of hybrid surgical treatment of symptomatic NOCA is high, which seems safe and effective. Patients with complete vessel collapse may require more endovascular treatment, and the long-term recovery of vessel diameter is worse than that of patients with incomplete collapse.

To explore the feasibility, safety and effectiveness of distal aspiration procedure with intermediate catheter in the endovascular treatment of severe cerebral venous sinus thrombosis (CVST).

This study enrolled a total of 37 patients with severe CVST who underwent the distal aspiration procedure with intermediate catheter in the Neurointerventional Department, First Affiliated Hospital of Zhengzhou University from January 2016 to December 2021. A retrospective analysis was conducted on the technical success rate, vein sinus recanalization and procedure-related complications. Clinical and imaging outcomes were followed up. The modified Rankin scale (mRS) score was used for clinical follow-up, with a score of 0-2 indicating good outcome and a score of ≥3 indicating poor outcome.

Among the 37 patients, the success rate of the distal aspiration with intermediate catheter was 97.3% (36 patients), and 1 patient (2.7%) only underwent venous sinus thrombolysis. Immediate postoperative angiography showed that the venous sinus was completely recanalized in 6 cases (16.2%), partially recanalized in 30 cases (81.1%), and 1 case (2.7%) was not recanalized. A total of 5 cases (13.5%) experienced procedure-related complications after surgery, and 1 case (2.7%) suffered from venous sinus perforation; 4 cases (10.8%) developed cerebral herniation, of which 1 case (2.7%) also developed right femoral vein thrombosis, 3 patients (8.1%) died of cerebral herniation. The median follow-up time after surgery for the 34 surviving patients was 6 months (3-8 months). During the follow-up period, 1 case of venous sinus thrombosis recurred. At the end of follow-up, 32 cases had mRS of 0-2 points and 2 cases had mRS of 3 points; the overall good outcome rate of 37 patients was 86.5%(32/37). Twenty-nine patients underwent imaging follow-up, of which 25 (86.2%) had good sinus recanalization and 4 (13.8%) had incomplete recanalization.

Distal aspiration procedure with intermediate catheter is a technically feasible, relatively safe, and effective method in the endovascular treatment of severe CVST patients.

To investigate the predictive role of hemodynamic parameters monitored during superficial temporal artery(STA)-middle cerebral artery(MCA) bypass surgery and perioperative blood pressure on cerebral hyperperfusion syndrome (CHS) in patients with ischemic moyamoya disease (MMD).

A retrospective analysis was conducted on 123 patients with ischemic MMD who underwent unilateral STA-MCA bypass surgery at the Department of Neurosurgery, the First Affiliated Hospital of Soochow University from January 2018 to December 2022. Intraoperatively, microprobe-vascular doppler (MVD) was used to monitor and record the hemodynamic parameters of the recipient artery MCA cortical branch (M4) and the donor artery, i. e., superficical temporal artery (STA), including peak systolic velocity (Vp), mean velocity (Vm), end-diastolic velocity (Vd), and pulsatility index (PI). Perioperative blood pressure changes were also recorded. Patients were divided into CHS group (32 cases) and non-CHS group (91 cases) based on the presence or absence of CHS clinical manifestations postoperatively. A multivariate logistic regression model was established to analyze the risk factors for postoperative CHS. The diagnostic value of predicting postoperative CHS was analyzed through receiver operating characteristic (ROC) curve and AUC (area under the curve).

There were no statistically significant differences in age, sex, hypertension, hyperlipidemia, or blood lipid levels between the two groups (all P>0.05). The CHS group had higher Vp, Vm, and Vd in the proximal segment of M4, higher Vm and Vd in STA, and higher intraoperative and postoperative blood pressure compared with the non-CHS group(all P<0.05). Multivariate logistic regression analysis results showed that higher Vm in the proximal segment of M4(OR=1.06, 95%CI: 1.01-1.12, P=0.014), intraoperative (OR=1.08, 95%CI: 1.00-1.16, P=0.040) and postoperative systolic blood pressure (OR=1.09, 95%CI: 1.01-1.17, P=0.023) were risk factors for postoperative CHS. ROC curve analysis showed that Vm of 52 cm/s in the proximal segment of M4 (AUC=0.83, 95%CI: 0.74-0.93), intraoperative systolic blood pressure of 131 mm Hg (1 mm Hg=0.133 kPa, AUC=0.84, 95%CI: 0.75-0.94), and postoperative systolic blood pressure of 148 mm Hg (AUC=0.75, 95%CI: 0.64-0.86) (all P<0.01) were the optimal cut-off values for predicting postoperative CHS, with a sensitivity of 0.742, 0.742, 0.839 respectively and a specificity of 0.867, 0.822, 0.644 respectively. The combined model of the three (AUC = 0.90, 95%CI: 0.84-0.97, P<0.01, sensitivity: 0.839, specificity: 0.844) had higher accuracy in predicting postoperative CHS.

Higher Vm in the proximal segment of M4, intraoperative, and postoperative systolic blood pressures are independent risk factors for postoperative CHS in MMD patients. The combination of the three has higher accuracy in predicting postoperative CHS.

To explore the clinical features and surgical treatment of ruptured distal posterior inferior cerebellar artery (PICA) aneurysms.

A retrospective study was conducted on the clinical data of 13 patients with distal PICA aneurysms who were admitted to the Neurosurgery Department of the Third Affiliated Hospital of Shanxi Medical University from January 2013 to December 2023. There were 11 patients who underwent microneurosurgical management and 2 patients who underwent simple endovascular coil embolization. The characteristics of the disease and the operative outcomes were analyzed.

The Hunt-Hess grade was Ⅱ in 5 patients, Ⅲ in 4 patients, Ⅳ in 2 patients and Ⅴ in 2 patients at admission. The bleeding was mainly distributed in the cerebellar medullary cistern, cisterna magna, cerebellopontine angle cistern, the other subarachnoid space of posterior cranial fossa, fourth ventricle, cerebellar vermis and cerebellar hemispheres. The aneurysm was located in the anterior medullary segment in 1 case, lateral medullary segment in 4 cases, tonsillomedullary segment in 5 cases, telovelotonsillar segment in 1 case, and cortical segment in 2 cases. There were 11 saccular aneurysms and 2 fusiform aneurysms. The maximum diameter of the aneurysm was 0.3 cm to 2.5 cm. Aneurysms were completely eliminated and PICA remained patent in the operation among 13 cases. There was 1 patient who exhibited transient injury of lower cranial nerves, 1 patient who exhibited the cerebral infarction with ataxia and 3 hydrocephalus patients who underwent ventriculoperitoneal shunt, one of which died. At 6-month follow-up, there were 1 case of Glasgow grade Ⅰ, 2 cases of grade Ⅲ, 1 case of grade Ⅳ, and 9 cases of grade Ⅴ; 8 cases of imaging follow-up showed no recurrence of aneurysm, and the PICA was patent.

Most of distal PICA aneurysms are saccular. PICA aneurysms are more common in the lateral medullary segment and tonsillomedullary segment. The incidence of hydrocephalus is high. Both endovascular coil embolization and craniotomy microsurgery can achieve good outcomes.

To evaluate the safety and efficacy of Neuroform Atlas (Atlas) stent-assisted coil embolization of acute ruptured intracranial wide-necked aneurysms.

A retrospective analysis was conducted on the clinical data of 61 patients with acute ruptured intracranial wide-necked aneurysms (61 aneurysms) treated with Atlas stent-assisted embolization at the Department of Neurosurgery, Heze Municipal Hospital from January 2021 to June 2023. The clinical outcomes were evaluated at 3 months after surgery using the Modified Rankin Scale (mRS) Score, with a score of 0-2 indicating a good outcome. Raymond grade was used to evaluate the degree of embolization of the aneurysm immediately post surgery and during follow-up, and to evaluate the cure (complete embolization) rate of the aneurysm and the incidence of in-stent stenosis.

A total of 64 stents were used in 61 aneurysms, and all were successfully released. Immediate post-embolization results showed as follows: raymond grade Ⅰ in 43 cases (70.5%), grade Ⅱ in 12 cases (19.7%), and grade Ⅲ in 6 cases (9.8%). No hemorrhagic complications occurred during the perioperative period, and ischemic complications occurred in 5 cases (8.2%); 2 cases died. Two cases were lost to follow-up, and 57 cases completed the 3-month postoperative follow-up, including 50 cases with mRS score of 0, 5 cases with 1 score, 1 case with 2 scores, and 1 case with 3 scores; the good outcome rate was 94.9% (56/59). A total of 47 cases underwent DSA follow-up, and the follow-up time was 7.6±1.5 months (6 to 11 months) after surgery; 42 cases (89.4%) of aneurysm were cured, 1 case (2.1%) had a stable aneurysm, and 4 cases (8.5%) had aneurysm recurrence; no new in-stent stenosis occurred.

The cure rate of Atlas stent-assisted coil embolization in the treatment of acute intracranial rupture of wide-necked aneurysms seems high, but the risk of ischemic complications is also high.

To explore the relationship between morphological and hemodynamic parameters of intracranial mirror aneurysms and their ruptures.

The clinical data of 30 patients (60 aneurysms in total) with intracranial mirror aneurysms admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from January 2017 to June 2022 were retrospectively analyzed. Raw data from patients′ cranial CT angiography (CTA) were collected, imported into Mimicus modelling, and a 3-MATIC smooth model was selected for parallel hemodynamic simulation calculations using Fluent to delineate the fluid domain. Eleven morphological parameters, including the aneurysm neck width of intracranial aneurysms, were measured and calculated based on the 3D CTA data. Morphological and haemodynamic parameters of the ruptured side of the mirror image aneurysm were compared with those of the unruptured side, and multivariate logistic regression analyses were performed to identify independent risk factors for aneurysm rupture.

Compared with the unruptured side of the intracranial mirror aneurysm, the aneurysm height on the ruptured side [M(Q₁, Q₃)] was [4.59 (3.80, 6.67) mm] vs. [2.73(2.31, 3.82) mm], the maximum height was [5.94 (4.39, 7.28) mm] vs. [3.44 (2.49, 5.06) mm], the maximum diameter was [5.50 (3.63, 7.00) mm] vs. [3.42 (2.82, 4.32) mm], the neck width was 4.78±1.52 mm vs. 3.64±1.23 mm, the aspect ratio was [1.16 (1.00, 1.86) ] vs. [0.99 (0.70, 1.23)], the height ratio was [2.18 (1.42, 3.23)] vs. [1.24 (0.97, 1.87)], height-to-width ratio was [1.03 (0.79, 1.50)] vs. [0.85 (0.59, 1.12)], and all those differences were significant (all P<0.05). However, there was no statistically significant difference in the inflow angle, irregular shape, average diameter of the parent artery, bottleneck factor, wall pressure, wall shear stress, or flow velocity between the two sides (all P≥0.05). The results of the multivariate logistic regression model analysis showed that the aneurysm height, maximum height, maximum diameter, neck width, aspect ratio, size ratio, or height-to-width ratio was not independent influencing factors of aneurysm rupture (all P>0.05).

The height, maximum height, maximum diameter, aneurysm neck width, aspect ratio, size ratio, and height-to-width ratio of intracranial aneurysms may be related to their ruptures.

To investigate the surgical treatment of residual or recurrent intracranial ependymoma in children.

The clinical data of 90 children with residual or recurrent ependymoma admitted to the Department of Pediatric Surgery at Peking University First Hospital from March 2014 to August 2023 were retrospectively analyzed. Among them, 32 cases had residual tumors after initial operation, and 58 cases had recurrent tumors. The tumor was located in the posterior cranial fossa in 60 cases and supratentorial region in 23 cases, and metastasis of the original posterior cranial fossa tumor to the lateral ventricle was identified in 7 cases. After surgery, patients were followed up either at the outpatient department or through telephone interviews to assess survival status, follow-up treatments, the last follow-up time was in October 2023, and recurrence/metastasis using head MRI scans.

All 90 cases underwent successful operations, including extended resection in 10 cases, total resection in 71 cases and near-total resection in 9 cases. Postoperative complications occurred in 78 cases (86.7%) including fever in 70 cases, subcutaneous effusion in 39 cases, hoarseness and dysphagia in 16 cases, and facial paralysis in 13 cases.Thirteen cases (14.4%) underwent ventriculoperitoneal shunt surgery for secondary hydrocephalus after surgery, and two of them died 24 h after surgery due to gastrointestinal bleeding and heart failure, respectively. One case died of postoperative pneumonia after discharge. After surgery, the pathological diagnosis of 69 cases remained consistent with initial diagnosis, comprising 5 cases classified as WHO grade 2, 62 cases classified as WHO grade 3, and 2 cases classified as WHO grade 2-3.The pathological diagnosis of 21 cases differed from the initial diagnosis, with 7 cases upgrading from WHO grade 2 to grade 3, 1 case upgrading from grade 1 to grade 2, 9 cases upgrading from grade 2-3 to grade 3, and 4 cases downgrading from grade 3 to grade 2. All 87 patients were followed up, with a follow-up time [M (range)] of 16 months (3-116 months). Among them, 49 patients received primary or salvage radiotherapy, while 3 patients received chemotherapy alone and another 3 patients received both radiotherapy and chemotherapy. At the last follow-up visit, tumor recurrence or metastasis led to the demise of 27 patients. Among the 60 surviving children, local recurrence was observed in 5 patients and spinal cord metastasis occurred in 2 patients.

The treatment effect of residual or recurrent intracranial ependymoma in children remains to be not ideal, and surgical resection assisted by postoperative radiotherapy is still the main treatment method.

To investigate the clinical characteristics indicating high-grade non-enhancing gliomas based on MRI by comparing with those of patients with non-enhancing low-grade gliomas.

The clinical data of adult patients with non-enhancing hemispheric gliomas based on MRI who were surgically treated and pathologically diagnosed from January 2021 to December 2023 in the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. The clinical characteristics between the high-grade (WHO grade 3 and 4) and low-grade (WHO grade 2) patients were compared using univariate analysis. The indicators with P<0.05 were further included in the multivariate logistic regression model to explore the characteristics indicating high-grade tumor.

A total of 126 MRI non-enhancing glioma patients were included, of which 46 cases (36.5%) were in the high grade group (including 38 WHO grade 3 cases and 8 WHO grade 4 cases) and 80 cases (63.5%) were in the low-grade group. Univariate analysis showed that age, tumor growth rate, relative apparent diffusion coefficient, choline(Cho)/creatine(Cr) ratio and Cho/N-acetylaspartate(NAA) ratio were significant risk factors between groups (all P<0.05), while sex, seizure, tumor size or site, T2-fluid attenuated inversion recovery mismatch sign, tumor pathology were not significant (all P>0.05). Multivariate analysis showed that age >40 years (OR=3.55, 95% CI: 1.30-11.48), tumor growth rate >8 mm/year (OR=17.30, 95%CI: 7.89-41.94), lower relative apparent diffusion coefficient (OR=0.77, 95% CI: 0.56-0.97) in MR diffusion weighted imaging, higher Cho/Cr ratio (OR=1.14, 95% CI: 1.08-1.20) and higher Cho/NAA ratio (OR=3.73, 95%CI: 1.50-9.35) in MR spectroscopy imaging were significantly associated with high grade (all P<0.05).

For patients with gliomas that show no enhancement on MRI, who are over the age of 40 and (or) have a tumor growth rate greater than 8 mm/year, there should be a high level of vigilance for the possibility of the lesion being of high grade before surgery. Further functional magnetic resonance imaging, including diffusion weighted imaging and/or MR spectroscopy, can facilitate preoperative grading.

To explore the influencing factors of permanent cerebrospinal fluid diversion for hydrocephalus after posterior fossa tumor surgery in children.

The clinical data of children with posterior fossa tumors admitted to the Neurosurgery Center of Zhujiang Hospital of Southern Medical University from January 2011 to December 2022 were retrospectively analyzed. According to whether the children underwent permanent cerebrospinal fluid diversion after surgery, they were divided into the diversion group and the non-diversion group, and the differences in the clinical data between the two groups were analyzed. The factors that were statistically significant in the univariate analysis were included in the multivariate logistic regression analysis to determine the important risk factors for the need for permanent cerebrospinal fluid diversion after surgery.

A total of 165 children were enrolled. Among them, 110 (66.7%) had preoperative hydrocephalus and 35 (21.2%) underwent a postoperative permanent cerebrospinal fluid diversion. Univariate analysis showed that compared with the non-diversion group (130 cases), a higher percentage of children in the diversion group (35 cases) had preoperative interstitial cerebral edema [91.4% (32/35) vs. 73.1% (95/130)], and the neutrophil-to-lymphocyte ratio (NLR) in the first postoperative peripheral blood examination was higher [M(Q₁, Q₃): 8.9 (5.0, 20.3) vs. 5.7 (3.4, 11.1)], and the differences were statistically significant (all P<0.05); whereas the differences in sex, age, disease duration, preoperative hydrocephalus, preoperative tumor dissemination, tumor location, pathological type of tumor, tumor grade, extent of tumor resection, operator, postoperative ventricular blood, preoperative peripheral white blood cell counts, preoperative peripheral blood NLR, or postoperative first-time peripheral white blood cell counts between the two groups were not statistically significant (all P >0.05). Multivariate logistic regression analysis showed that both preoperative interstitial cerebral edema (OR=5.29, 95%CI: 1.40-19.95, P=0.014) and a high NLR in the first postoperative peripheral blood examination (OR=1.07, 95%CI: 1.02-1.11, P=0.002) were important risk factors for the need for permanent cerebrospinal fluid diversion after surgery.

Children with posterior fossa tumors who have preoperative interstitial cerebral edema and a high NLR in the first postoperative peripheral blood examination are at higher risk of needing permanent cerebrospinal fluid diversion after tumor surgery.

To investigate the effect of transfrontal ventricle choroidal fissure approach in thalamic glioma resection.

The clinical data of 21 patients with thalamic glioma who underwent transfrontal ventricle choroidal cleft approach in the Neurosurgery Department of Shiyan Taihe Hospital from January 2017 to October 2023 were retrospectively analyzed. Surgery was performed through the middle frontal gyrus into the body of the lateral ventricle. During the operation, based on the positional relationship between the tumor and the choroid plexus, 4 cases of tumors with the main body located in the third ventricle were resected through the medial side of the choroidal fissure into the third ventricle, and 17 cases of thalamic tumors were resected through the lateral side of the choroidal fissure. The tumor resection process was assisted by yellow fluorescent staining technology. The tumor resection rate was evaluated by postoperative MRI images. After discharge, follow-up treatment plan and prognosis were tracked by phone, etc.

Among the 21 patients, 11 cases (52.4%) had total tumor resection, 4 cases (19.0%) had subtotal resection, 5 cases (23.8%) had majority resection, and 1 case (4.8%) had biopsy. Among the 11 patients with hydrocephalus before surgery, 8 patients had significant relief of hydrocephalus after surgery, and the related headache and memory impairment were significantly improved. Among the 3 patients with hemiparesis on one side of the limb, 2 patients were improved in the short term after surgery. There were 3 cases of postoperative electrolyte disorders and 3 cases of new postoperative limb paralysis of varying degrees. Two patients underwent ventricular drilling + Ommaya capsule placement due to hydrocephalus after surgery, and three patients underwent ventriculo-peritoneal shunt 1 to 2 months after surgery. The postoperative follow-up time [M (range)] of 21 patients was 11 months (6 weeks to 73 months). By the last follow-up, 15 patients had died, and their survival period [M (range)] was 10 months (6 weeks to 24 months); 6 patients were alive. Among the surviving patients, 2 cases of diffuse astrocytoma recurred 6 months and 10 months after surgery respectively, and both underwent regular radiotherapy and chemotherapy after surgery again without tumor recurrence. One case of glioblastoma relapsed 7 months after surgery and underwent no further treatment. Two case of anaplastic oligoastrocytoma received regular postoperative radiotherapy and chemotherapy, and no tumor recurrence was found during the follow-up. One case of pilocytic astrocytoma showed no recurrence after a 73-month follow-up.

The transfrontal ventricle choroidal fissure can be taken for resection of gliomas that invade the entire thalamus, third ventricle and bilateral thalamus, moreover, the tumor resection rate is higher, the complications are less, and the short-term symptoms can be effectively alleviated.

To investigate the application value of neurointerventional technique in the treatment of refractory epistaxis after transsphenoidal endoscopic surgery.

A retrospective analysis was conducted on the clinical data of 21 patients with refractory epistaxis after transsphenoidal endoscopic surgery who underwent endovascular interventional embolization at Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from January 2015 to May 2022. Postoperative bleeding and related complications were evaluated and determined. Patients were followed up by telephone or outpatient examination for recurrence.

All the 21 patients underwent successful cerebral angiography, and 2 cases were negtive, the positive rate was 90.5% (19/21). According to the results of angiography, 14 patients with bilateral abnormal mucosal staining underwent interventional embolization of bilateral distal branches of internal maxillary artery for hemostasis, 4 patients with unilateral abnormal mucosal staining underwent interventional embolization of unilateral distal branches of internal maxillary artery, and 1 patient with internal carotid artery pseudoaneurysm underwent covered stent placement. After the operation, the symptoms of epistaxis in 21 patients were completely improved, and the treatment effect was good. Among them, 8 cases (38.1%) had maxillofacial pain, 4 cases (19.1%) had toothache, 2 cases (9.5%) had facial numbness, and 7 cases (33.3%) had no obvious complications. The follow-up time of 21 patients was 4.10±2.05 months (1-10 months). At the last follow-up, no recurrence of epistaxis was identified.

Interventional embolization is safe and effective for the treatment of refractory epistaxis after transsphenoidal endoscopic surgery, which has high clinical application value.

To investigate the clinical utility of optical coherence tomography (OCT) in the assessment of stent apposition following flow diverter (FD) implantation models in the common carotid artery (CCA) and internal maxillary artery (IMA) of Bama mini-piglets.

Tubridge FDs were implanted in the CCA (8 pigs) and IMA (4 pigs) of 12 Bama mini-piglets aged 3~4 months, with one Tubridge FD in each experimental pig. OCT and high-resolution C-arm CT were conducted immediately following stent implantation to assess the FD apposition. Digital subtraction angiography (DSA) was performed 12 weeks post procedure to assess the stent patency. Concurrently, OCT was utilized to examine the degree of endothelialization. Histopathological analysis was carried out on the CCA and IMA at the site of FD implantation. In addition, the effect of incomplete stent apposition (ISA) on stent endothelialization was analyzed.

A total of 12 FDs were implanted, with 8 placed in the CCA and 4 in the IMA. Immediately following FD implantation, OCT revealed 21 ISAs at the distal or local in 12 FDs. However, high-resolution C-arm CT indicated that 2 ISAs were present distally in only 2 FDs implanted in the IMA, while the other FDs exhibited complete apposition. At 12 weeks post procedure, DSA demonstrated lumen occlusion in 1 FD, whereas no significant stenosis was observed in the remaining 11 FDs. OCT finding indicated that aside from 1 stent occlusion, 4 out of 11 FDs displayed poor stent endothelialization characterized by 8 ISAs; conversely, 7 exhibited good stent endothelialization. Histopathology revealed that the single occluded FD presented with intracavitary thrombus. In 4 FDs, there was no apparent intimal coverage at the distal or local braided wire. Excellent intimal hyperplasia was identified in 7 FDs. At 12 weeks post FD implantation, measurements showed that the distance between the stent braid wire and inner vessel wall at ISAs averaged 612.80±15.75 μm for 4 poorly endothelialized stents and 495.57±64.03 μm for 7 well endothelialized stents, and the difference was statistically significant (P=0.003). Among the 18 ISAs detected by OCT immediately following procedure (excluding 3 sites of stent occlusion), the distances between the stent braid and inner vessel wall were >600 μm for 8 ISAs and 400-600 μm for 10 ISAs. At 12 weeks post FD implantation, the follow-up assessments revealed 7 ISAs of poor endothelialization alongside 1 ISA of good endothelialization within >600 μm group; conversely, 1 ISA of poor endothelialization and 9 ISAs of good endothelialization were noted within 400-600 μm group. A statistically significant difference existed regarding degree of endothelialization between these 2 groups (P=0.003).

OCT can accurately assess FD apposition and endothelialization process, which is in high consistency with histopathology. The degree of FD apposition has an effect on stent endothelialization.

To investigate the expression levels of long non-coding RNA (LncRNA) Maternally Expressed Gene 3 (MEG3) in Growth Hormone (GH) cell adenoma tissues and its clinical and pathological correlation.

The ChipBase v3.0 database was utilized to analyze the correlation between MEG3 expression in normal pituitary tissues and lineage differentiation factors such as Nuclear Receptor Subfamily 5 Group A Member 1 (NR5A1), POU Class 1 Homeobox 1 (POU1F1), T-Box Transcription Factor 19 (TBX19), GH, Growth Hormone Receptor (GHR), Growth Hormone Releasing Hormone Receptor (GHRHR), Insulin Like Growth Factor 1 Receptor (IGF1R), and Somatostatin Receptor 2/5 (SSTR2/5). Tumor samples were obtained from 28 patients with GH cell adenomas at the Neurosurgery Department of Tangshan People′s Hospital. MEG3 levels in the tumor tissues were detected using RT-qPCR. Immunohistochemistry staining was used to assess the expression levels of GH, GHRHR, and SSTR 5 in tumor tissues. Pearson correlation analysis was conducted to evaluate the relationship between MEG3 gene levels and the expression levels of GH, GHRHR, and SSTR 5 in the tumor samples. Based on MEG3 gene expression levels, patients were divided into two groups: the high expression group (expression level≥0.14, 14 cases) and the low expression group (expression level<0.14, 14 cases). The correlation between MEG3 gene expression levels and the clinical pathological characteristics of the patients was analyzed.

Among the 31 organs, pituitary gland was ranked 1st(r=0.60), 9th (r=0.32) and 29th (r=0.28) in the correlation relationship of MEG3 with POU1F1, NR5A1 and TBX19, respectively (all P<0.05). The pituitary gland were all ranked first in terms of the correlation relationship of GH (r=0.60), GHRHR (r=0.72) and SSTR 5 (r=0.57), and 4th in IGF1R (r=0.74), 18th in GHR (r=0.28) (all P<0.05), and no correlation in SSTR 2 (P>0.05). Pearson correlation analysis showed that the MEG 3 level was positively correlated with the immunohistochemistry scores of GH, GHRHR and SSTR 5 in the specimens (r=0.59, 0.65, 0.47, respectively). The differences in tumor volume and maximum diameter between patients in the high MEG3 expression group and the low expression group were not statistically significant (both P>0.05). The Ki-67 proliferation index for the high and low MEG3 expression groups were 2.0% (1.5%, 2.6%) and 3.0% (2.0%, 6.6%), respectively, with a statistically significant difference (Z=2.11, P=0.001). The proportion of patients with a Ki-67 proliferation index >3.0% was 2/14 and 6/14 in the high and low MEG3 expression groups, respectively, with no statistically significant difference between the two groups (P=0.088). Transmission electron microscopy results showed that the proportion of cells containing a large number of dense spherical granules was 10/14 in the high MEG expression group and 3/14 in the low MEG expression group, with statistically significant difference (P=0.001).

MEG3 may promote the differentiation of pituitary tumors into GH cell tumors and the synthesis of GH, and it could inhibit tumor proliferation. The level of MEG3 expression may influence the type of hormone granules in the tumor.

To systematically evaluate the predictive value of intraoperative facial nerve motor evoked potentials (FNMEP) on facial nerve function after surgery for patients with cerebellopontine angle area tumors.

A computer search was performed on PubMed, Embase, Cochrane Library, VIP, CNKI, and Wanfang database for articles published from January 2005 to November 2023 on the diagnostic research on intraoperative FNMEP for predicting facial nerve function after surgery for tumors in the cerebellopontine angle area, regardless of language or region. Two researchers independently extracted data and used the QUADAS-2 scale to evaluate the quality of the literature. Meta-analysis was performed using Stata (17.1) software to evaluate the predictive value of intraoperative FNMEP for facial nerve function in the early postoperative period (<1 week after operation) and long-term (≥6 months after operation) for tumors in the cerebellopontine angle area. The combined sensitivity and combined specificity were calculated. The receiver operating characteristic curve was drawn and the area under the curve (AUC) was calculated. Heterogeneity was quantitatively analyzed using the I² value. If I² was ≤ 50%, the fixed effect model was used for analysis; if I² was > 50%, the random effects model was used for analysis. Subgroup analysis was conducted based on different early warning criteria (amplitude or threshold method) and different tumor types (acoustic neuroma or non-acoustic neuroma patients).

A total of 19 studies with a total of 1, 494 patients were included. Meta-analysis results showed that the combined sensitivity of FNMEP for predicting early and long-term facial nerve function after surgery was 0.85 (95%CI: 0.77-0.90, P<0.001) and 0.89 (95%CI: 0.79-0.95, P<0.001) respectively, the combined specificities were 0.92 (95%CI: 0.87-0.96, P<0.001) and 0.93 (95%CI: 0.73-0.99, P<0.001) respectively, and the combined AUCs were 0.94 (95%CI: 0.92-0.96, P<0.001) and 0.93 (95%CI: 0.90-0.95, P<0.001) respectively. Subgroup analysis showed that the combined sensitivities of the amplitude method and the threshold method were both 0.85 (both P<0.05), the combined specificities were 0.92 and 0.94 respectively (both P<0.05). The combined sensitivities of the non-acoustic neuroma group and the acoustic neuroma group were 0.97 and 0.85 respectively (both P<0.05), and the combined specificities were 0.93 and 0.84 respectively (both P<0.05).

Intraoperative FNMEP has a high predictive value for early and long-term postoperative facial nerve function in patients with cerebellopontine angle tumors.

Anterior cervical myelomeningocele with Klippel-Feil syndrome is very rare. A child with this disease was diagnosed and treated in the Department of Neurosurgery, Children's Hospital affiliated to Suzhou University in January 2024. The clinical manifestation was that the neck was skewed to the left side and moved well, without other neurological symptoms. MRI and CT examination of cervical and thoracic vertebrae showed multiple vertebral deformities of cervical and thoracic vertebrae, anterior cervical myelomeningocele and Klippel-Feil syndrome. The children received conservative treatment and were followed up for 3 months without new symptoms of neurological injury.

Middle meningeal artery pseudoaneurysm is relatively rare in clinical practice. It is often formed by occult rupture of arteries caused by skull fracture, firearms, iatrogenic causes, etc. Delayed epidural hemorrhage is the most common. For example, dura injury will lead to hemorrhage into the skull. In February 2024, a patient with traumatic intracranial hemorrhage was admitted to the Department of Neurosurgery of Nantong University Affiliated Hospital. After 10 days of conservative treatment, sudden hematoma enlargement occurred, and intracranial hemorrhage occurred again 2 hours after intracranial hematoma evacuation. Digital subtraction angiography was used to diagnose a right middle meningeal artery pseudoaneurysm rupture with intracranial hemorrhage. Two months after endovascular embolization, CT reexamination showed intracranial hematoma resorption. The patient's left limb muscle strength was grade I, the right limb was grade III, and the muscle tone was slightly decreased. The modified Rankin scale score was 4 points.

Stereoscopic electroencephalography (SEEG) -guided radiofrequency thermocoagulation damage (RF-TC) is an effective treatment for epilepsy caused by focal cortical dysplasia (FCD). In February 2022, the All-Army Neurosurgery Center of the 988th Hospital of the Joint Logistics Support Force of the People's Liberation Army used SEEG-guided RF-TC to treat a patient with drug-refractory epilepsy caused by FCD at the right frontal sulcus sulcus floor. After operation, there was gas accumulation, necrosis and liquefaction in the damaged area, and extensive intractable cerebral edema around it, resulting in decreased muscle strength at the distal end of the left upper limb, decreased flexibility of the left hand, and stiff fingers. The cystic lesion was removed by craniotomy 4 weeks after RF-TC operation, and the cerebral edema gradually subsided and the function of left upper limb and left hand recovered after 5 months of rehabilitation after the second operation.

As a novel glucagon-like peptide 1 (GLP-1) analogue, semaglutide has better protease resistance and higher receptor affinity than other analogues. The drug has been used in many basic and clinical studies. It has been confirmed to have the effects of lowering glucose, weight loss, reducing the occurrence of cardiovascular adverse events in patients with type 2 diabetes, and treating non-alcoholic hepatitis. With the deepening of research, the role of semaglutide in the nervous system has gradually attracted people's attention. Some studies have reported that semaglutide can inhibit neuroinflammatory response and improve the survival rate of nerve cells in neurological diseases such as epilepsy, stroke and Parkinson's disease, thereby improving the cognitive function and movement disorders of patients. In this paper, the role of GLP-1 and semaglutide in nervous system and vascular, degenerative and degenerative diseases of nervous system is summarized and described.

The expression of various inflammatory factors in the serum of patients with Cushing's disease is elevated. Even if the hormone secretion is effectively controlled after operation, its expression is still in an elevated state. Long-term elevated inflammatory factors are the risk factors of a series of complications in patients with Cushing's disease. In recent years, the relationship between intestinal microbes and inflammation has received attention, and the close association of flora with inflammation has been reported in a variety of diseases. The relative abundance of intestinal microbes was altered in patients with Cushing's disease compared to healthy people, such as increased numbers of Proteobacteria and Shigella bacteria and decreased numbers of Firmicutes bacteria. Intestinal microbial disorders may be an important cause of long-term low-grade inflammation in patients with Cushing's disease. Therefore, this article reviews the relationship between intestinal microorganisms and inflammation of Cushing's disease and discusses its internal mechanism, in order to provide help for the clinical treatment of Cushing's disease.