Volume 40 · Issue 12 · 2024

Subarachnoid hemorrhage (SAH) is a kind of stroke subtype that seriously endangers human life and health. Its mortality rate is 32% ~67%, which causes serious adverse effects on the country, society and family. In recent years, with the development of neurosurgical techniques and neurointensive care techniques, the clinical treatment effect of SAH has been greatly improved, but a considerable proportion of patients still have long-term advanced neurological dysfunction (mainly cognitive and emotional dysfunction). At present, the clinical translation of SAH basic research results still cannot significantly improve the prognosis of patients. In addition, clinicians often focus on the acute phase after the onset of SAH, while ignoring the adverse effects of long-term advanced neurological dysfunction on patients, their families, and society. Therefore, this article focuses on the research status and significance, possible intervention targets and treatment strategies of long-term advanced neurological dysfunction after SAH.

Patients with acute craniocerebral trauma (TBI) have increased intracranial pressure (ICP) due to intracranial hemorrhage, edema, cerebral infarction, brain swelling and other reasons. Intracranial hypertension remains the leading cause of death and disability in patients with TBI^[1,2,3]。 How to effectively control intracranial hypertension is a challenge and difficult problem faced by neurosurgeons all over the world. In recent decades, European and American countries have successively published stepped treatment protocols for intracranial hypertension^[4,5,6]。 However, years of clinical practice have proved that there are still many incomplete and unreasonable contents in the stepped treatment plan of intracranial hypertension currently in use. For example, the stratified treatment of intracranial hypertension is only suitable for patients with gradually increased ICP after TBI, and it cannot be used for emergency patients with dilated pupils, massive intracranial hemorrhage and cerebral contusion and laceration with cerebral hernia. Another example, Yumans-Winn Neurosurgery, 5th edition^[6]And Management under Intracranial Pressure Monitoring: Seattle International Severe Craniocerebral Trauma Expert Consensus Meeting^[4]Unreasonable treatments such as barbiturate coma and hyperventilation are still recommended. Therefore, we propose a management procedure for acute TBI intracranial hypertension (Figure 1), in order to be more scientific and rational, more suitable for China's national conditions, and more operable.

To investigate the outcomes of stereoelectroencephalography(SEEG)-guided surgery in patients with drug-refractory epileptic spasm (ES) and the prognostic factors.

Patients with drug-refractory ES admitted to the Neurosurgery Department of Tsinghua University Yuquan Hospital (Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital) from December 2013 to April 2023 were retrospectively analyzed and those required second-stage evaluation for SEEG electrode placement after noninvasive preoperative evaluation were enrolled. Based on SEEG results and imaging characteristic, individualized surgical treatment plans were determined, including radiofrequency thermocoagulation, epileptogenic zonectomy, and laser ablation. Patients were divided into a seizure-free group (Engel Ⅰ grade) and a non-seizure-free group (Engel Ⅱ-Ⅳ grade) based on the presence or absence of seizures after surgery. SEEG characteristics and outcomes of patients were summarized and the influencing factors of surgical outcome were explored.

A total of 29 patients were enrolled into this study. SEEG results were classified into three types based on the SEEG characteristics during ES: SEEG type Ⅰ in 6 cases, SEEG type Ⅱ in 13 cases, and SEEG type Ⅲ in 10 cases. Among 29 patients, 11 patients underwent radiofrequency thermocoagulation, 14 patients underwent epileptogenic zonectomy, and 4 patients underwent laser ablation. All patients were followed up with a median of 37 months (range: 14-103 months). Nineteen patients (65.5%) were seizure free after focal resection or thermal coagulation, including 6 patients of SEEG type Ⅰ, 11 patients of SEEG type Ⅱ, and 2 patients of SEEG type Ⅲ. The difference in SEEG seizure types between the seizure-free group and the non-seizure-free group was statistically significant (P=0.003). The proportion of seizure-free patients in SEEG types Ⅰ (6/6) and Ⅱ (11/13) was higher than that in type Ⅲ patients (2/10) (both P<0.05), while the difference between type Ⅰ and type Ⅱ patients was not statistically significant (P>0.05). The age of onset and surgical age of patients in the seizure-free group were both lower than those in the seizure group (both P<0.05). The proportions of patients with focal positive findings on head MRI and unilateral SEEG electrode placement were both higher in the seizure-free group than in the non-seizure-free group (both P<0.05). There was no statistically significant difference between the two groups in terms of the disease course, interical EEG or ictal EEG type, the characteristics of spastic seizures, or whether or not there was positive finding in positron emission tomography-computed tomography (all P>0.05).

Patients with drug-refractory ES who undergo SEEG-guided surgery can achieve a high postoperative seizure free rate. Children with young onset age, young surgical age, suspicious focal lesion or tuberous sclerosis detected by cranial MRI, and SEEG indicating the origin of focal attacks or focal "leading spikes" have better surgical outcomes.

To investigate the clinical efficacy and influencing factors of vagus nerve stimulation (VNS) for drug-resistant epilepsy.

The clinical data of 61 patients diagnosed with drug-refractory epilepsy and treated with VNS in the Epilepsy Center, the Second People′s Hospital of Hunan Province (Hunan Brain Hospital) from January 2016 to January 2023 were retrospectively collected. Among them, there were 28 cases of primary disease, 4 cases of epilepsy due to brain trauma, 4 cases of stroke, and 25 cases of other secondary etiologies. The disease duration was 7.21±1.87 years (0.5-18.0 years), and 2 (1, 3) types of antiseizure drugs [M(Q₁, Q₃)] were taken. Preoperative Quality of Life in Epilepsy-31(QOLIE-31) score of patients was 59.18±6.66. Patients were clinically followed up at 6, 12 and 18 months after VNS, and their quality of life was assessed using the QOLIE-31 score. McHugh grading criteria were used to evaluate the therapeutic effect of VNS 18 months after surgery, and the factors that might affect postoperative effect were analyzed.

The VNS operations were successfully completed in 61 patients. After operation, 5 patients (8.20%) had transient adverse reactions, including transient hoarseness in 3 cases and nausea in 2 cases at the first boot. Sixty-one patients took 2 (1, 3) types of antiseizure drugs [M(Q₁, Q₃)] after surgery, and there was no statistically significant difference compared with preoperative levels (Z=-0.83, P=0.405). The scores of QOLIE-31 were 82.50±1.82, 87.80±3.11 and 88.11±3.11 at 6, 12 and 18 months after operation respectively. The scores of QOLIE-31 were significantly different before and after surgery (F=849.68, P<0.001). Compared with preoperative conditions, the QOLIE-31 scores were higher at different postoperative times, and the differences were statistically significant (all P<0.05). At 18 months after surgery, 13 cases were classified as McHugh gradeⅠ, 24 cases as grade Ⅱ, 13 cases as grade Ⅲ, 8 cases as grade Ⅳ, and 3 cases as grade Ⅴ. There were no significant differences in age, gender, type of medication, seizure type, brain MRI results, or the origin of VEEG seizures among patients with different MuHugh grades (all P>0.05). Patients with MuHugh grades Ⅰ-Ⅱ have a shorter disease course than those with grades Ⅲ-Ⅴ. Among patients with traumatic brain injury, stroke, and other secondary causes, patients with MuHugh grades Ⅰ-Ⅱhave a higher proportion than those with grades Ⅲ-Ⅴ, and the differences are statistically significant(both P<0.05).

VNS can effectively treat drug-refractory epilepsy and improve the quality of life of patients. VNS seems to be associated with better therapeutic effects for patients with short disease duration and epilepsy caused by stroke, traumatic brain injury and other subsequent factors.

To analyze and summarize the clinical characteristics and prognosis of epilepsy secondary to Sturge-Weber syndrome (SWS).

A retrospective analysis was conducted on 9 SWS patients who underwent preoperative evaluation for epilepsy in the Department of Neurosurgery at Tsinghua University Yuquan Hospital (Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital) from January 2013 to March 2024. Six patients underwent surgical treatment after preoperative evaluation, which included 1 case of right hemispherectomy, 1 case of right hemispherotomy, and 4 cases of resections of less than a hemisphere (1 case of unilateral temporo-parieto-occipital resection, 2 cases of unilateral temporo-parieto-occipital disconnections, and 1 case of focal tailored resection). Three patients received medical treatment. The clinical characteristics and outcomes were documented.

This group had 5 SWS Ⅰ and 4 SWS Ⅲ cases. The median age of seizure onset was 8 months (range: 1 month to 7.5 years). All 9 patients had focal seizures, including 2 with focal epileptic spasms. MRI T1-enhanced scans of 8 patients showed localized leptomeningeal enhancement (one hemisphere involved in 4, part of one hemisphere involved in 3, and both hemispheres involved in 1). All patients showed signs of focal cortical dysplasia (FCD) on MRI, such as unclear gray-white matter junctions. The median follow-up time for the 6 surgical patients was 2.9 years (range: 0.6-10.5 years), with 4 patients achieving Engel class Ⅰ and 2 patients achieving Engel class Ⅱ (relapsed at 10 months and 5.0 years postoperatively, with >90% reduction in seizure frequency). Two patients with preoperative video EEG abnormalities exceeding the surgical resection area relapsed after surgery, while among the two patients with imaging abnormalities exceeding the resection area, only one relapsed. None of the three patients receiving medical treatment had recurrence during follow-up.

Epilepsy secondary to SWS has an early onset, with focal seizures being the most common type. In addition to leptomeningeal vascular malformations, MRI often shows FCD features. Resective surgery could lead to good postoperative seizure control. Preoperative video EEG abnormalities exceeding the resection area may be associated with postoperative seizure relapse.

To investigate the effect of quadruple nerve decompression in the treatment of painful diabetic peripheral neuropathy of lower extremity.

The clinical data of 24 patients (40 sides) with painful diabetic peripheral neuropathy of lower extremities were retrospectively analyzed in the Department of Neurosurgery at China-Japan Friendship Hospital from January 2020 to December 2020. Those patients underwent quadrilateral decompression surgery on their peripheral nerves, including the common peroneal nerve of the peroneal canal, deep peroneal nerve of the dorsal foot, superficial peroneal nerve of the anterior lower leg 1/3, and medial ankle posterior tibial nerve and its branches. All patients were followed up every three months after discharge for evaluation using Visual Analogue Scale (VAS), two-point discernability (TPD), sensory nerve conduction velocity (SCV), and Toronto Clinical Neuropathy Score (TCSS). Preoperative and postoperative comparisons were performed to evaluate the surgical efficacy.

All patients successfully underwent the operations. No postoperative complications occurred. The 24 patients were followed up for 28.5±8.7 months (14-44 months). Up to the last follow-up, compared with those before surgery, postoperative VAS score of 40 sides (1.85±1.23 points vs. 6.53±1.13 points), TPD measurement results (7.48±2.35 mm vs. 13.00±3.16 mm), SCV of common peroneal nerve (CPN) (42.13±2.97 m/s vs. 35.75±3.28 m/s) and SCV of posterior tibial nerve (PTN) (42.07±2.75 m/s vs. 35.02±3.03 m/s) were improved, and the differences were statistically significant (all P<0.001). The results of TCSS showed that all 24 patients had severe diabetic peripheral neuropathy before surgery, 2 had severe, 15 had moderate, and 7 had mild diabetic peripheral neuropathy after surgery. Postoperative TCSS was significantly improved compared with preoperative TCSS (9.42±1.53 points vs. 13.88±1.08 points, P<0.001).

Quadruple decompression of peripheral nerve can improve the pain symptoms and nerve function of patients with painful diabetic peripheral neuropathy of lower extremity. It is an effective method for the treatment of painful diabetic peripheral neuropathy of lower extremity.

To observe the feasibility and efficacy of microscopic surgery in treating recurrent trigeminal neuralgia (TN) after Gamma knife surgery.

A retrospective analysis was conducted on patients with recurrent TN who underwent microscopic surgery in the Neurosurgery Department of Wuxi Second People′s Hospital from January 2010 to April 2021. Among the 19 patients included in the study, 2 had initially received microvascular decompression (MVD) before undergoing nerve root decompression after Gamma knife treatment. Of the 17 patients primarily treated with Gamma knife surgery, 4 underwent merely MVD, while 13 received MVD combined with nerve root decompression. The Barrow Neurological Institute (BNI) pain intensity score was utilized to evaluate the degree of pain relief, and surgical efficacy along with related complications were monitored.

All 19 patients underwent successful surgery. During the perioperative period, 14 patients achieved complete pain relief, 4 experienced partial relief, and 1 had ineffective outcome. Among the patients with partial relief, 3 had only undergone MVD. The average follow-up duration for the 19 patients was 63.9±13.9 months, ranging from 48 to 96 months. Among the 15 patients who underwent MVD combined with nerve root decompression, 14 patients had no recurrence during the follow-up period, while 1 patient with partial relief experienced no change in the pain level. Of the 4 patients who underwent merely MVD, 2 showed no significant changes, and both patients with partial relief experienced recurrence 8 months after surgery.

The use of microsurgical techniques to treat recurrent TN after Gamma knife surgery is feasible and associated with no serious surgery-related complications. The efficacy of patients who underwent only MVD is limited, and MVD combined with nerve root decompression could more effectively alleviate pain symptoms.

To explore the role of 3D printed guide plate in percutaneous balloon compression (PBC) for the treatment of medically refractory trigeminal neuralgia (TN).

Clinical data of 39 patients with drug-refractory TN treated with PBC from October 2020 to October 2023 at the Department of Neurosurgery of the First Affiliated Hospital of Shihezi University were retrospectively collected. Among them, 16 patients chose to use 3D-printed guides to assist PBC (experimental group); 23 patients refused to use 3D printed guides and were punctured with bare hands under digital subtraction angiography guidance (control group). The number of patent foramen ovale punctures, puncture time, total procedure duration, dose of contrast used, duration of balloon compression, pear shape formation of balloon, postoperative Barrow Neurological Institute (BNI) pain intensity score, and the occurrence of procedure-related complications were compared between the two groups.

All 39 patients underwent successful operation. Compared with the control group, the study group had fewer intraoperative punctures of the foramen ovale [1(1, 2) vs. 2 (2, 3)], shorter puncture time [1.8 (1.0, 3.8) min vs. 6.0 (3.0, 16.0) min], and shorter total operative time [29.6±3.9 min vs. 46.3±15.1 min], and the differences were statistically significant (all P<0.001). The success rate of "pear-shaped" balloon [75.0%(12/16) vs. 60.9%(14/23)] and the success rate of "pear-shaped" balloon at one time [62.5%(10/16) vs. 13.0%(3/23)] were both higher. However, the difference in the success rate of "pear-shaped" balloon was not statistically significant (P=0.495), while the difference in the success rate of "pear-shaped" balloon at one time was statistically significant (P=0.002). There were no serious postoperative complications in either group, and the difference in the proportion of facial numbness, difficulty in mastication or herpes was not statistically significant in the study group except for the proportion of swelling at the puncture site, which was smaller than that in the control group [12.5% (2/16) vs. 56.5% (13/23), P=0.008]. The difference in the BNI score between the two groups at 3 months postoperatively was not statistically significant (P=0.922).

PBC assisted with 3D printed guide plate for drug-refractory TN can effectively improve the success rate of puncture, shorten the operation time and reduce the risk of surgery.

To investigate the clinical characteristics and prognostic features of multilineage pituitary neuroendocrine tumors (PitNETs).

A retrospective analysis was conducted on the clinical data of 369 patients with PitNETs who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from January 2019 to October 2021. The patients were divided into multilineage PitNETs (i.e., those with positive expression of at least 2 pituitary transcription factors) and three monolineage PitNETs (including PIT1, SF1 and TPIT lineages) based on the postoperative pathological results. The clinical features and outcomes of multilineage PitNETs patients were summarized, and comparisons were made with those of the three monolineage patients.

Compared with the SF1 lineage, patients with multilineage PitNETs had a higher invasive tendency [proportion of Knosp grade 3-4: 48.3% (42/87) vs. 31.5% (28/89), P=0.023]. Compared with the TPIT lineage, the maximum diameter of their tumors was smaller (25.4±11.4 mm vs. 30.2±13.4 mm, P=0.014). Compared with SF1 lineage [3.4% (3/89)] and TPIT lineage PitNETs patients [16.5%(13/79)], multilineage PitNETs patients [31.0% (27/87)] showed more obvious symptoms of hormone oversecretion (both P<0.05). During a median follow-up period of 27 months, patients with multiple lineage PitNETs [71.2% (47/66)] had a higher clinical symptom improvement rate than those with PIT1 lineage [37.5% (36/96)] and SF1 lineage [44.8% (26/58)] (both P<0.05), and were more prone to pituitary dysfunction compared with patients with TPIT lineage [incidence rate: 55.8% (29/52) vs. 26.8% (11/41), P=0.005].

The clinical attributes and prognosis associated with multilineage PitNETs diverge from those of any monolineage PitNETs, delineating a distinct subtype with unique clinical features.

To investigate whether the use of sodium fluorescein would increase the extent of resection of brain metastases, and to examine whether the resection guided by sodium fluorescein would affect the postoperative neurological status and have a positive effect on the postoperative prognosis.

A retrospective analysis was conducted on the data of patients with brain metastases who underwent surgical resection at the Department of Neurosurgery, Inner Mongolia People′s Hospital from January 2016 to August 2023. A total of 84 patients were enrolled. There were 45 cases in the sodium fluorescein guided group treated with sodium fluorescein microscope to remove the tumor and 39 cases in the non-sodium fluorescein guided group removed under the traditional white light microscope. MRI was performed within 72 hours after surgery in all patients. Preoperative and postoperative T1-enhanced MRI were used to evaluate the extent of resection. We then analyzed the differences in the Karnofsky Performance Status Scores (KPS) 3 months after surgery, local recurrence rates and survival rates 1 year after surgery between the two groups of patients.

There were no statistically significant differences in baseline data such as gender, age, preoperative KPS, and location of brain metastases between the two groups of patients (all P>0.05), indicating that the two groups were comparable. Surgeries were successfully completed for all patients in both groups. Early-stage postoperative MRI showed that among the 45 patients in the observation group, 33 cases (73.3%) had no tumor residue, 9 cases (20.0%) had no measurable tumor residue, and 3 cases (6.7%) had measurable tumor residue; among the 39 patients in the control group, 21 cases (53.8%) had no tumor residue, 9 cases (23.1%) had no measurable tumor residue, and 9 cases (23.1%) had measurable tumor residue. Compared with the control group, the proportion of patients with no tumor residue after surgery was higher in the observation group (P=0.037). Compared with the control group, the KPS of patients in the observation group was higher at 3 months after surgery (86.60±9.16 points vs. 82.12±7.50 points), and 1-year local recurrence rate was lower [8.9% (4/45) vs. 25.6% (10/39)], and the differences were statistically significant (both P<0.05). However, there was no statistically significant difference in the 1-year survival rate between the two groups [51.1% (23/45) vs. 38.5% (15/39), P=0.245].

Fluorescein sodium-guided surgery can help improve the resection extent of brain metastases and reduce the local recurrence rate of tumors, while it does not seem to improve the one-year survival rate of patients.

To explore the efficacy and safety of tirofiban for mechanical thrombectomy in patients with acute large vessel occlusion cerebral infarction.

The clinical data of 218 patients with acute large vascular occlusive cerebral infarction treated by mechanical thrombectomy in the Department of Neurosurgery and Department of Neurology of Tianjin Teda Hospital from October 2018 to December 2022 were prospectively included. The patients were divided into study group (109 cases) and control group (109 cases) according to whether tirofiban therapy during perioperative period was applied or not. Platelet count was rechecked 48 h after thrombectomy to evaluate the difference due to antiplatelet drug treatment. Cranial MRI was performed to observe the infarction site and the presence of intracranial hemorrhage. The National Institutes of Health Stroke Scale (NIHSS) was scored 48 h and 10 d after treatment, and the difference in the NIHSS between pretreatment and posttreatment periods was calculated to evaluate the improvement of neurological function in the two groups. The modified thrombolysis in cerebral infarction classification (mTICI) was used to evaluate the vascular recanalization in the two groups. The modified Rankin scale (mRS) was used to evaluate the outcome difference between the two groups through outpatient, telephone or video follow-up 3 months after treatment (mRS ≤ 2 points for good outcome, >2 points for poor outcome). According to the different sites of cerebral infarction, the study group and the control group were divided into anterior circulation subgroup (68 and 62 cases, respectively) and posterior circulation subgroup (41 and 47 cases, respectively). The differences in baseline data and vascular recanalization after mechanical thrombectomy between the two groups were analyzed in the subgroups.

There were no significant differences in the baseline data such as gender, age, and combined severe stenosis or occlusion of non-responsible major arteries between the study group and control group (all P>0.05). The NIHSS scores at 48 h and 10 d after treatment (48 h: 9.34±3.90 scores vs.10.74±4.39 scores; 10 d: 8.22±4.25 scores vs. 9.84±4.82 scores), and 48 h vascular re-occlusion rates [5.50%(6/109)vs.14.68%(16/109)] of patients in the study group were lower than those in the control group, and the difference of NIHSS scores before and after treatment [M(Q₁, Q₃), between 48 h and before treatment: 6.00(4.00, 8.00)scores vs.4.00(0, 7.00)scores; between 10 d and before treatment: 7.00(4.00, 10.00)scores vs.6.00(0.50, 9.00)scores], the vascular reocclusion rate [88.07%(96/109)vs.71.56%(78/109)], the success rate of ≤3-times thrombectomy [77.06%(84/109)vs.60.55%(66/109)], the effective reocclusion rate [72.48%(79/109)vs.55.05%(60/109)]and the good prognosis rate[71.56%(78/109)vs.56.88%(62/109)] were higher than those in the control group, and the differences were statistically significant(all P<0.05).There were no significant differences in platelet count, intracranial hemorrhage rate, symptomatic intracranial hemorrhage rate and mortality between the two groups after treatment (all P>0.05).There were no significant differences in gender, age, pre-treatment NIHSS scores and other baseline data between the two anterior circulation subgroups and the two posterior circulation subgroups (all P>0.05).The vascular revascularization rate[85.29%(58/68)vs.69.35%(43/62)], the success rate of ≤3-times thrombectomy[70.59%(48/68)vs.53.23%(33/62)], the effective revascularization rate [63.24%(43/68)vs.45.16%(28/62)]and the good outcome rate[73.53%(50/68)vs.51.61%(32/62)] in the anterior circulation subgroup of the study group were higher than those in the control group, and the differences were statistically significant(all P<0.05).The NIHSS scores in the posterior circulation subgroup of the study group was lower than that in the control group at 48 h: (8.27±3.49 scores vs. 10.94±5.06 scores) and 10 d: 6.85±3.48 scores vs. 9.17±4.97 scores) after treatment, and the difference of NIHSS scores before and after treatment[M(Q₁, Q₃), between 48 h and before treatment: 7.00 (5.00, 9.50)scores vs.4.00 (0, 8.00)scores; between 10 d and before treatment: 9.00(5.50, 10.00)scores vs.7.00(3.00, 10.00)scores], rate of vascular recirculation[92.68%(38/41)vs.74.47%(35/47)], success rate of ≤3-times thrombectomy[87.80%(36/41)vs.70.21%(33/47)] and effective recirculation rate [87.80%(36/41)vs.68.09%(32/47)]were higher than those in the posterior circulation subgroup of the control group, the differences were statistically significant (all P<0.05).

Tirofiban can effectively reduce the NIHSS scores in patients with mechanical thrombectomy of large blood vessel occlusion, increase the vascular revascularization rate, and effectively improve the prognosis of patients. The effect of the treatment for anterior and posterior circulation of large blood vessel occlusion is not completely consistent, while it seems safe and effective in both situations.

To evaluate the efficacy and safety of Wallstent combined with flow diverter (FD) in treatment of long extracranial dissection of the internal carotid artery.

A retrospective analysis on clinical and imaging data of patients with long extracranial carotid artery dissection treated with Wallstent combined with FD in the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from March 2021 to June 2023. The efficacy and safety of the operation were evaluated according to the results of immediate postoperative angiography, perioperative complications, postoperative symptom improvement and the follow-up results.

Fourteen patients met the enrollment criteria and were enrolled into this study, including 5 patients with dissecting aneurysm and 9 patients with simple arterial dissection. In all patients, one Wallstent and one Tubridge FD were sequentially implanted at the dissection lesions with partial overlap of stents, and the technical success rate was 14/14. Immediate postoperative angiography showed that all stents were well attached, and obvious contrast agent retention was observed in 5 dissecting aneurysms, and lumen blood flow was restored in 9 patients with simple dissection lesions. No serious complications such as acute stent thrombosis, blood vessel rupture, and bleeding were observed during perioperative period. All patients received clinical follow-up for 3 to 19 months, with an average follow-up time of 10.14±1.18 months. One patient developed contralateral limb weakness (muscle strength grade Ⅲ) at 11 months after surgery, and CT angiography (CTA) indicated intrastent luminal occlusion. Muscle strength returned to normal after treatment with drugs such as antiplatelet and dilatancy, with no residual limb movement disorder. No new neurological symptoms or signs were found in the remaining 13 patients at the last follow-up. Postoperative imaging follow-up was obtained for 13 patients, including 6 cases of digital subtraction angiography (DSA) and 7 cases of CTA. The follow-up time [M(Q₁, Q₃)] was 8 (6, 9) months. In addition to 1 patient with intrastent occlusion, the remaining 12 patients showed complete aneurysm occlusion (4 cases) or disappearance of dissection lesion (8 cases) while the carrying artery remained unobstructed.

Wallstent combined with FD implantation is a safe and effective treatment for long extracranial intersectional dissection of internal carotid artery. However, due attention should be paid to the occurrence of chronic intrastent occlusion after surgery.

To explore the preliminary experience of distal radial artery approach (dTRA) in neurointerventional diagnosis and treatment, and to evaluate its safety and feasibility.

A retrospective analysis was conducted on the clinical data of 62 patients who underwent neurointerventional diagnosis and treatment with dTRA in the Department of Neurointerventional Surgery, Affiliated Hospital of Binzhou Medical University from January to August 2023. The radial artery diameter was measured by Doppler ultrasound before the procedure. The radial artery was punctured using the modified Seldinger technique, and the 6F radial artery sheath was used to establish access in all cases. Complications and patency of the punctured artery were assessed by Doppler ultrasound 1 day or 30 days after the procedure. The technical success rate of neurointerventional diagnosis and treatment via dTRA (success was defined as good blood ejection from the end of the puncture needle, smooth transmission of the guidewire, and successful placement of the arterial sheath and catheter) and puncture-related complications were observed and documented.

Preoperative Doppler ultrasound measured the forearm radial artery diameter as 2.3±0.3 mm and the diameter of the distal radial artery as 1.8±0.3 mm. All 62 patients underwent diagnostic cerebrovascular angiography, of which 11 cases (17.7%) underwent interventional treatment during the same procedure. The success rate of neurointerventional treatment via dTRA was 75.8% (47/62), of which 13 cases were transformed to the proximal radial approach (pTRA), and 2 cases were transformed to the transfemoral artery approach. Reasons for failure included repeated puncture failure in 11 cases, sheath insertion failure in 3 cases, and failure to place the left vertebral artery in 1 case due to insufficient proximal catheter support via the right dTRA. The catheterization time was 268.2±142.6 s. Doppler ultrasound 1 day after procedure did not reveal weakened pulse in the forearm or distal radial artery or hand ischemic events, and only one case experienced transitory numbness around the puncture site, which resolved spontaneously. One patient who transformed to pTRA due to failed dTRA puncture developed forearm pain at 30-day postoperative follow-up, and Doppler ultrasound showed mid-distal radial thrombosis.

Neurointerventional treatment via dTRA is clinically safe and feasible, with few overall complications. However, due to its relatively small diameter and difficulties in puncturing and inserting sheath, a certain learning curve needs to be overcome to improve the success rate of the procedure.

To explore the application value of intraoperative neuroelectrophysiological monitoring (IONM) in brainstem cavernous malformation (BSCM) surgery.

A retrospective analysis was conducted on the clinical data of 17 patients with BSCM who were admitted to the Department of Neurosurgery, the Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital) from November 2022 to November 2023. All patients presented different degrees of neurological symptoms before surgery, and BSCM resection was performed with the assistance of IONM, including somatosensory evoked potentials (SSEPs), transcranial electric motor evoked potentials (Tce-MEPs), facial motor evoked potentials (FMEPs), brainstem auditory evoked potentials (BAEPs), brainstem mapping, and cranial nerve electromyography. The patient′s IONM data, postoperative neurological improvement and complications were documented. Postoperative head MRI was performed within 48 h after the surgery to evaluate surgical resection rate of BSCM. Follow-up cranial MRI was performed 3, 6, and 12 months after surgery to further evaluate the resection degree and recurrent rate of BSCM. The Karnofsky Functional Status scale(KPS) was used to assess the neurological status of patients at discharge and final follow-up.

All 17 patients underwent SSEPs and Tce-MEPs monitoring, with selective BAEPs (8 cases), FMEPs (3 cases), and cranial nerve electromyography (6 cases) monitoring. Mapping monitoring was performed in 4 cases to determine facial nerve motor nuclei. There were no significant changes in intraoperative or postoperative monitoring waveforms in 11 patients. However, some changes were recorded in the amplitude and latency of SSEPs or Tce-MEPs during surgery in 6 patients, including 5 transient changes and 1 persistent abnormal SSEPs. None of the patients had occurrence of IONM-related complications, such as epileptic seizure, arrhythmia, scalp burns at the stimulation electrode site, or direct thermal injury. All 17 surgical operations with BSCM were successfully performed. Total resection was achieved in 16 cases, subtotal resection was performed in 1 case, and the residual BSCM with small postoperative hematoma was completely removed to achieve total resection immediately after the first surgery. Postoperative pathological examination confirmed the diagnosis of BSCM. All patients were conscious after surgery, and no death was documented. Postoperatively, neurological improvement was reported in 12 cases, neurological status remained unchanged in 2 cases, and 3 patients experienced temporary worsening of neurological symptoms. Two patients experienced postoperative complications, including 1 case of cerebrospinal fluid nasal discharge and 1 case of mild acute subdural bleeding.The follow-up period for 17 patients was 3(2, 11)months. At the last follow-up, no residual or recurrent cavernous malformations was found in the follow-up MRI. Clinical symptoms did not significantly worsen, and 3 patients with postoperative worsening neurological function showed improvement in symptoms after rehabilitation treatment. The KPS of the 17 patients before surgery, at discharge and the last follow-up were 80.59±7.48, 85.88±11.76, and 91.76±9.51 respectively, which demonstrated statistically significance (F=19.53, P<0.001). The KPS at discharge was higher than that before surgery but lower than that at the last follow-up (both P<0.05).

The application of IONM can help the surgeons to remove BSCM safely and maximally in BSCM surgery. Thus, postoperative neurological improvement and reduced surgical related complications could be achieved.

To investigate the effect of arterial partial pressure of carbon dioxide (PaCO₂) fluctuation on short-term prognosis of children with severe traumatic brain injury (sTBI) during mild hypothermia treatment.

We collected and analyzed the clinical data of 51 children with sTBI admitted to Department of Emergency Neurosurgery in Qilu Hospital of Shandong University from January 2018 to June 2023. All children received PaCO₂ control during hypothermia treatment, dynamic arterial blood gas monitoring and transcranial Doppler ultrasound (TCD) monitoring in initial treatment, and the target value of PaCO₂ was set according to TCD results, and the range of minute ventilation was determined by adjusting tidal volume and respiratory rate. According to the standard deviation (s) of all PaCO₂ values during mild hypothermia treatment of each child, all cases were divided into two groups, namely, the PaCO₂ fluctuation small group (s≤5 mm Hg, 1 mm Hg=0.133 kPa, 19 cases) and large group(s>5 mm Hg, 32 cases). Then, we compared the duration of mild hypothermia treatment, total length of hospital stay, incidence of postoperative cerebral infarction, highest value of blood neuron specific enolase (NSE), Glasgow Coma Score (GCS) at discharge, and GCS at 6 months follow-up between the two groups. Patients received out-patient or telephone follow-up at 6 months after discharge. Pearson correlation analysis was used to analyze the correlation between the s value of PaCO₂ and GCS value at 6 months.

There were no significant differences in age, gender distribution and admission GCS between two groups (all P> 0.05). Compared with the PaCO₂ fluctuation large group, the duration of mild hypothermia treatment (97.3±11.3 h vs. 108.2±12.5 h) and the duration of hospitalization (16.8±3.8 d vs. 18.9±3.3 d) in the small fluctuation group were shorter, discharge GCS (9.4±1.1 points vs. 8.3±1.3 points) and 6 months follow-up GCS (13.6±1.5 points vs. 10.8±1.8 points) were higher (all P< 0.05). There was no significant difference in maximum value of NSE or incidence of cerebral infarction between the two groups (both P>0.05). There was a negative correlation between s value of arterial PaCO₂ and GCS value at 6 months follow-up (r=-0.66, P<0.001).

The small fluctuation of arterial PaCO₂ in children with sTBI during mild hypothermia is conducive to shortening the time of mild hypothermia treatment and total length of hospital stay, and stable arterial PaCO₂ is associated with good short-term prognosis.

To construct a mouse model of spinal muscular atrophy (SMA) by mating breeding and genotype identification of heterozygous genetically engineered mice, and to analyze the biological characteristics of the constructed off spring SMA mice.

SMA model mice were obtained by mating and breeding of FVB.SMNΔ7 hybrid mice (8 females, 4 males). The amplified product of motor neuron survival protein 1 (SMN1) gene was obtained by polymerase chain reaction (PCR) through the mouse tail genome DNA template of the offspring mice, and the genotype was identified by agarose gel electrophoresis to screen out the SMA model mice. According to the results of genotype identification, the mice were divided into three groups: wild type, heterozygote and SMA. The body and muscle development of neonatal SMA mice were measured by righting reflex test and muscle fiber density measurement (n=5). The ontogeny of offspring mice was evaluated by body mass measurement, righting reflex test and survival curve analysis at different developmental time points(n=6). The expression of SMN protein in spinal cord was detected by immunohistochemistry (IHC), immunofluorescence (IF) and Western blot (WB)(n=3).

Genetic tests showed that about 25% (8/32) of the offspring of FVB.SMNΔ7 heterozygous mice were homozygous SMN1 mutant mice, namely SMA mice. The righting reflex time of SMA mice was longer than that of heterozygous mice and wild-type mice (t values: 7.48 and 16.48, respectively, both P<0.05). The muscle fiber density of the hind limbs of mice showed that the number of muscle fibers per unit cross-sectional area of SMA mice was lower than that of wild-type mice and heterozygous mice (both P<0.05). The body mass of SMA mice at day 0, 1, 7, 10 and 13 was lower than that of wild type and heterozygote mice (all P<0.05). And at different time points, the ring-over reflex time of offspring SMA mice was longer than that of wild-type and heterozygous mice (all P<0.05). The median survival time of SMA mice was 14.80±2.60 d, which was lower than that of wild-type and heterozygous mice (both P<0.05). The IHC results showed that the expression level of SMN protein in the spinal cord of SMA mice was lower than that of wild-type and heterozygous mice (t values: 41.78 and 15.36, respectively, both P<0.05). IF and WB results also showed that the expression level of SMN protein in the spinal cord of SMA mice was lower than that of wild-type and heterozygous mice (both P<0.05).

In this study, a mouse model of SMA has been successfully constructed. Offspring SMA mice have shown poor physical and muscle development, ontodevelopmental delay, and decreased SMN protein expression in the spinal cord, which are consistent with the pathological manifestations of SMA.

The incidence of primary diffuse midline glioma of the spinal cord is extremely low, its invasiveness is strong, and it often leads to spinal cord dissemination and intracranial metastasis, and bone metastasis is rare. In November 2023, a patient with bone metastasis after primary diffuse midline glioma of the thoracic spinal cord was admitted to the Department of Oncology of the Affiliated Hospital of Jining Medical College. Combined with the previous treatment, he was treated with paclitaxel polymer micelles combined with bevacizumab for one course of treatment, but his condition did not improve significantly. The patient and his family gave up treatment, and the patient died of respiratory failure 23 months after the operation.

Perimedullary arteriovenous fistula (SPAVF) is an arteriovenous fistula located in the subarachnoid spinal cord of the spinal cord. The peak incidence is 1 to 4 years old. SPAVF onset in infancy is rare, and there are fewer reports of onset and cure in infancy. A patient with intraventricular hemorrhage 57 days after delivery was diagnosed with SPAVF hemorrhage caused by intraventricular hemorrhage. After external ventricular drainage, intravascular coil embolization was used to treat the patient with intracranial pressure and lower limb muscle strength improved significantly. There was no recurrence of SPAVF in spinal cord MRI 2 months after operation.

Hypocranial pressure hydrocephalus (LPH) after craniocerebral injury is extremely rare in clinic. Because of the contradiction between ventricular enlargement and decreased intracranial pressure, it is difficult to identify and diagnose. In clinical practice, early diagnosis and early precise treatment of LPH are very important to improve patients' quality of life and prognosis. A patient with LPH after craniocerebral injury was admitted to the Department of Neurosurgery, Huaihe Hospital, Henan University in March 2024. The patient's signs were consistent with the symptoms of hydrocephalus, and lumbar puncture showed low intracranial pressure; The cerebrospinal fluid flow imaging examination of the midbrain aqueduct was considered as hypodynamic hydrocephalus (non-sinusoidal flow pattern); The final diagnosis was LPH. After ventricular-peritoneal shunt with adjustable pressure shunt, patients' consciousness improved, ventricles shrank, and clinical symptoms improved significantly.

Meningiomas are the most common primary intracranial tumors. Although most of them are benign, about 20% of meningiomas will show malignant biological characteristics and are prone to recurrence after surgery. In the past, the long-term prognosis and the possibility of recurrence were judged mainly by the World Health Organization (WHO) pathological grade. However, in practical clinical work, some WHO grade 1 meningiomas relapse soon after surgery, while some patients with high grade meningiomas have a good prognosis, which suggests that there are certain deficiencies in applying traditional indexes to evaluate the prognosis of patients. In recent years, with the progress of molecular biology and imaging research, the industry's understanding and understanding of meningioma has been deepened, and there are more methods to improve the accuracy of predicting the recurrence of meningioma patients. In addition, for refractory meningiomas after relapse, more potential emerging treatment technologies are gradually being applied in the clinic. This article reviews the prediction methods of meningioma recurrence and the application progress of emerging therapeutic techniques after recurrence, in order to provide reference for clinical treatment decision-making of meningioma.

Glioma is the most common malignant tumor of central nervous system, with high mortality and recurrence rate. In recent years, the application of cellular immunotherapy as a novel immunotherapy in glioma has attracted attention. Natural killer (NK) cells are a kind of immune cells with clinical potential after T cells, which have attracted widespread attention in the field of anti-tumor immunotherapy. Chimeric antigen receptor (CAR) -NK cell therapy is a new cancer cell immunotherapy, which can kill cancer cells more accurately and then have an anti-tumor effect. This article reviews the characteristics and main therapeutic targets of CAR-NK cells in basic research of glioma, as well as the new challenges encountered by CAR-NK cells in basic research and clinical trials, and provides theoretical basis and new ideas for CAR-NK cell-based immunotherapy of glioma.