Volume 41 · Issue 01 · 2025

On the occasion of the beginning of the new year, on behalf of the editorial board and the editorial department of Chinese Journal of Neurosurgery, I would like to express my sincerest gratitude and highest respect to every friend who has long supported, paid attention to and contributed to this journal.

Time flies, the sun and the moon fly, and the Chinese Journal of Neurosurgery, which has accompanied the growth of several generations of neurosurgeons, ushered in its 40th birthday. Since the founding of Academician Wang Zhongcheng in February 1985, the magazine has made outstanding achievements in the aspects of journal construction, academic quality, circulation quantity and social benefit. At this moment, on behalf of myself, I would like to extend my sincere congratulations and high respect to the editorial board, editorial department, authors and neurosurgery colleagues who have worked hard for the development of Chinese Journal of Neurosurgery over the years! At the same time, I also express my heartfelt thanks to my neurosurgical colleagues and friends in the medical field who have cared and supported the journal for a long time!

With the rapid development of brain-computer interface technology, its application prospect in the field of neurosurgery has attracted much attention. In the clinical application of neurosurgery, brain-computer interface technology can be used to restore motor function, improve neurological rehabilitation, and help the brain communicate with the outside world, especially for patients with paralysis or aphasia. This paper discusses the current application status, challenges and prospects of brain-computer interface technology in the field of neurosurgery, in order to provide reference for researchers and clinicians, so as to promote the further development of brain-computer interface technology in the field of neurosurgery.

To explore the classification of membranous structures of vestibular schwannomas with vestibular nerve bundle membrane as the interface, and to study the clinical efficacy of individualized surgical strategies based on the classification.

A retrospective study was conducted to analyze the clinical data of 300 patients with vestibular schwannoma admitted to the Department of Neurosurgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2015 to December 2019. According to the integrity, clarity, and positional relationship with the facial nerve of the vestibular nerve bundle membrane, the membranous structures of vestibular schwannoma were classified into three types (type a/b/c: 72, 195 and 33 cases, respectively), and individualized surgery strategy was applied based on the aforementioned classification. The intergroup differences of clinical characteristics were analyzed. Postoperative facial nerve and hearing function were evaluated by House-Brackmann (H-B) grade and American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) scale at 1 month and 1 year after surgery by outpatient service or telephone review. H-B grades Ⅰ to Ⅱ indicated good facial nerve function; effective hearing function was defined as the average pure tone average (PTA) >50 dB and the speech resolution ≥50%.

Of the 300 patients, total resection was performed in 262 patients (87.33%), near total resection in 29 cases (9.67%) and subtotal resection in 9 cases (3.00%). Ten patients(3.33%) suffered from postoperative complications (cerebrospinal fluid leakage in 5 cases, hydrocephalus in 2 cases, incision infection in 1 case, cerebellum hemorrhage in 1 and remote hemorrhage of frontal lobe in 1). At 1-month and 1-year follow-up after surgery, the good facial nerve function ratio were 87.33% (262/300)and 88.67% (266/300) respectively. Among the patients who had effective hearing before surgery, the effective hearing retained ratios after surgery were 69.37% (154/222) and 70.27% (156/222) respectively. No statistical difference was established regarding patient age, gender or tumor side in intergroup comparison (all P>0.05). The differences in tumor texture and Koos grading were statistically significant (both P<0.05). The integrity and clarity of the membranous structure in cystic vestibular schwannoma were poorer than those in solid tumors. The clarity of tumor membrane structure in patients with Koos grading 3-4 was higher than that in patients with Koos grading 1-2.Of the patients in type b and type c, the proportion of Koos grade 3-4 was higher than that of type a, and the proportion of patients in type c was higher than that in type b (all P<0.05). There were statistically significant differences in the degree of tumor resection, facial nerve function, and hearing among the three types of patients at 1 month and 1 year post surgery (all P<0.001). Among them, patients with total tumor resection, good facial nerve function, and effective hearing retained had lower proportions of type b and c than that of type a, and the proportion of type c was lower than that of type b (all P<0.01).

Individualized surgery based on the classification of membranous structures in vestibular schwannomas could help achieve complete tumor resection, protect facial nerve function, and preserve effective hearing.Patients with poor integrity and clarity of the vestibular nerve bundle membrane, and severe adhesion to tumors, the prognosis seems poor, and special attention should be paid during surgery.

To analyze the pathological structure of the acoustic neuroma (AN) capsule in 4 patients, and to explore the clinical surgical resection strategy of AN.

A retrospective study was conducted on pathological specimens from 4 patients who underwent resection of acoustic neuroma via the retrosigmoid approach at the Department of Neurosurgery, Tianjin Medical University General Hospital from January 2024 to June 2024. During the operation, tissue samples were taken from the free surface of the sheath tumor capsule, the interface with the cranial nerve, and the dural-like membrane capsule of the internal auditory canal. After surgery, the tissues were stained with HE, immunohistochemistry (including S100 and myelin basic protein) and Masson three-color staining, and pathological analysis of the AN capsule structure was performed.

Preliminary pathological analysis of AN tissues in 4 patients showed that the free surface of the tumor was covered with a very thin layer of connective tissue, which was thinner than 10 μm in most areas and the perineurium of the vestibular nerve originating from AN. Only the perineurium remained to be on the surface of some tumors, and the cross-layer of nerve fiber layer and tumor cells could be seen on the surface of some tumors. The histopathological analysis of the AN-facial nerve (FN) interface showed that there were two types of structures at the AN-FN interface. For the first type, tumor parenchyma, cross-band of degenerative vestibular nerve fibers and FN nerve fibers, and FN nerve fibers were found from the inside to the outside. For the second type, the tumor parenchyma, tumor parenchymate-FN nerve fiber cross band, FN nerve fiber were observed from the inside to the outside. The histopathological analysis of the AN-vestibular junction showed that there was no clear boundary between AN and vestibular nerve fibers, and AN was originated from vestibular nerve. Sometimes, the boundary between the dural membrane and the vestibular nerve near the internal auditory canal was clear, and the interface was the tumor bearing vestibular nerve bundle membrane. Sometimes, the boundary was not clear, and there were many invasive tumor cells in the dural membrane tissue. On the other hand, There was no tumor cell invaded the arachnoid in the outermost layer of the sheath.

There are several types of membrane structures at the interface between AN and cranial nerve. Correct treatment of AN capsule structure during operation can effectively remove the tumor and protect the facial and auditory nerve functions of patients.

To analysis the influencing factors of surgical efficacy and biochemical remission of prolactin-secreting pituitary neuroendocrine tumors (PitNETs).

A retrospective analysis was conducted on the clinical data of 283 patients with prolactin-secreting PitNETs who underwent surgical operations at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023. Clinical follow-up was carried out through telephone interview and outpatient visits at 1, 3, 6 and 12 months after surgery to obtain information about postoperative medicine use. The prolactin level was detected by blood biochemical test, and MRI was used to evaluated the extent of resection and tumor recurrence. According to the prolactin level (biochemical remission), patients were divided into remission group (196 cases) and non-remission group (87 cases). The differences in clinical characteristics between the two groups were analyzed, and the factors with P<0.05 were included in the multivariate logistic regression analysis to explore the factors influencing postoperative biochemical remission.

The surgeries of all 283 patients were successfully completed. Among them, 196 cases (69.26%) achieved gross-total resection, 76 cases (26.85%) achieved near-total resection, 11 cases (3.89%) achieved partial resection. Postoperative complications occurred in 148 cases (52.30%), including 133 cases (47.00%) of short-term complications, among which there were 16 cases of cerebrospinal fluid rhinorrhea, 34 cases of diabetes insipidus, 53 cases of temporary hypopituitarism, 15 cases of intracranial infection, 8 cases of visual deterioration, and 7 cases of epistaxis. All were relieved after symptomatic treatment. Long-term complications occurred in 15 cases (5.30%), including 12 cases of permanent hypopituitarism and 3 cases of anosmia. Postoperative biochemical remission was achieved in 196 cases (69.26%), and no remission was observed in 87 cases (30.74%). All 283 patients received follow-up, and the follow-up time [M(Q₁, Q₃)] was 11.2 (5.0, 17.0) months. In the non-remission group, the prolactin level decreased to the normal level in 79 cases after bromocriptine treatment, and in 8 cases after cabergoline treatment. The last follow-up showed that no tumor recurrence occurred in any patient. There were no statistically significant differences in gender, age, preoperative tumor apoplexy, or tumor blood supply between the remission group and non-remission group (all P>0.05). The preoperative prolactin level in the remission group was significantly lower than that in the non-remission group. The proportions of patients with Knosp grade 0-2, micro-prolactin secreting PitNETs, endoscopic endonasal approach, existing pseudocapsule, gross-total resection and soft texture were significantly higher than those in the non-remission group (all P<0.05). The results of multivariate logistic regression analysis showed that the preoperative prolactin level (OR=1.98, 95%CI: 1.96-1.99, P=0.022) was the independent risk factor of postoperative biochemical remission. Knosp grade 0-2 (OR=0.69, 95%CI: 0.47-0.99, P=0.049), existing pseudocapsule (OR=0.45, 95%CI: 0.31-0.74, P=0.027)and gross-total resection (OR=0.75, 95%CI: 0.44-0.85, P=0.031) were the independent protective factors of postoperative biochemical remission.

Although the incidence of postoperative short-time complications is relatively high in the surgical treatment of prolactin-secreting PitNETs, surgical treatment is still an effective method. The preoperative prolactin level, Knosp grade, existing pseudocapsule and gross-total resection are the main factors influencing postoperative biochemical remission.

To explore the impact of cavernous sinus (CS) venous drainage patterns on the prediction of tumor laterality in patients with Cushing′s disease through bilateral inferior petrosal sinus sampling (BIPSS).

A retrospective analysis was conducted on the clinical data of 65 Cushing′s disease patients who underwent BIPSS at the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from August 2018 to February 2024. Based on digital subtraction angiography, the CS drainage patterns were categorized as symmetric or asymmetric. Tumor laterality was predicted according to the ratio of adrenocorticotropic hormone (ACTH) level in the inferior petrosal sinus (IPS) to that in the peripheral blood (IPS/peripheral ACTH). The association between predicted tumor laterality and intraoperative findings was analyzed using the continuous correction χ² test. Fisher′s exact test was employed to analyze correlations for symmetric and asymmetric drainage groups separately. Association analysis was performed with the Apriori algorithm on four transactional items: non-dominant side IPS/peripheral ACTH <1, non-dominant side IPS/peripheral ACTH≥1, tumor on the dominant side, and tumor on the non-dominant side.

Among the 65 Cushing′s disease patients, intraoperative findings showed left-sided tumors in 28 cases (43.1%), right-sided tumors in 36 cases (55.4%), and a midline tumor in 1 case (1.5%). BIPSS results indicated left-sided tumors in 23 cases (35.4%), right-sided tumors in 39 cases (60.0%), and midline tumors in 3 cases (4.6%). The continuous correction χ² test indicated a significant correlation between BIPSS-predicted and intraoperatively confirmed tumor laterality (χ²=34.93, P<0.001). Among the 25 cases with asymmetric drainage (16 with right dominance and 9 with left dominance) and 40 cases with symmetric drainage, BIPSS predictions matched the intraoperative tumor laterality in 37 symmetric cases (accuracy: 92.5%) and in 10 asymmetric cases (accuracy: 40.0%), with a statistically significant difference (adjusted χ²= 4.60, P<0.001). Fisher′s exact test indicated a correlation between BIPSS-predicted and intraoperatively confirmed tumor laterality in symmetric drainage cases (P<0.001), while there was no correlation in asymmetric drainage cases (P=0.411). However, there was a significant association between tumor laterality and whether the non-dominant IPS/peripheral ACTH was ≥1 (P<0.001). Further association analysis revealed two strong rules: when the non-dominant IPS/peripheral ACTH ratio was ≥1, the tumor was located on the non-dominant side, while if it was <1, the tumor was on the dominant side.

CS venous drainage patterns influence the ability of BIPSS to predict tumor laterality in Cushing′s disease. For patients with symmetric drainage, BIPSS results can be used to determine tumor laterality. For those with asymmetric drainage, if the non-dominant IPS/peripheral ACTH is <1, the tumor is likely on the dominant side, whereas if the ratio is ≥1, the tumor may be on the non-dominant side.

To explore the efficacy and safety of resection of anterior clinoidal meningiomas and epidural anterior clinoidectomy.

A retrospective study was conducted on the clinical data of 30 patients who underwent microsurgical resection of clinoidal meningiomas and epidural anterior clinoidectomy at the Department of Neurosurgery, the Second Affiliated Hospital of Air Force Medical University from January 2019 to November 2023. Preoperatively, the Al-Mefty classification was used, with 7 cases of type Ⅰ, 17 cases of type Ⅱ, and 6 cases of type Ⅲ. Follow-up was performed through outpatient visits at 3 months, 6 months, and 1 year postoperatively. Cranial MRI was used to assess the extent of resection and tumor recurrence. The patient′s visual condition was assessed through ophthalmic clinic, and the differences in postoperative visual improvement was analyzed among patients with different Al-Mefty types.

Microsurgical resection was successfully completed in all 30 cases with no intraoperative neurovascular injuries. Total tumor resection was achieved in 26 cases (86.7%, including 5 in Al-Mefty type Ⅰ, 15 in type Ⅱ, and 6 in type Ⅲ), and subtotal resection in 4 cases (13.3%, including 2 in Al-Mefty type Ⅰ and 2 in type Ⅱ). Postoperative pathological confirmation revealed 28 cases of WHO central nervous system tumors grade 1 and 2 cases of grade 2 (atypical). Five cases (16.7%) experienced postoperative complications, including 1 case of minor bleeding in the surgical area, 1 case of epileptic seizure, 1 case of oculomotor nerve palsy, and 2 cases of severe cerebral edema, all of which improved with symptomatic treatment. There were no cases of intracranial infection, cerebral infarction, or death. Among the 26 patients with preoperative vision loss, 19 cases showed significant vision improvement postoperatively, 5 cases remained unchanged, and 2 cases worsened. Four patients [3 cases with subtotal tumor resection and WHO grade 1; 1 case with total tumor resection and WHO grade 2 (atypical)] underwent postoperative stereotactic radiosurgery. The follow-up time for the 30 patients was 31.0±16.1 months (4 to 58 months); 2 cases had tumor recurrence at the last follow-up, 1 case underwent a second surgery for tumor resection, and 1 case with increased residual tumor continued to be observed. The comparison of postoperative vision among different Al-Mefty types showed that patients with type Ⅰ, Ⅱ, and Ⅲ had significant improvement in vision in 5, 11, and 3 cases respectively, and no change or worsening in 2, 6, and 3 cases respectively, with no statistically significant difference (P=0.769).

The total resection rate of anterior clinoid meningioma is high and the complications are mild after extradural anterior clinoidectomy.It is safe and effective. Additionally, patients with different Al-Mefty types benefit similarly in terms of postoperative vision.

To explore the expression characteristics and diagnostic value of BRAF-V600E mutant protein VE1 in various brain tumors.

The specimens of 120 patients with brain tumors who underwent pathological examination in the Department of Pathology, Guangdong Sanjiu Brain Hospital from October 2021 to October 2022 were retrospectively collected. Among them, there were 48 cases of gangliocytoma (GC)/ ganglioglioma (GG), 17 cases of dysembryonic neuroepithelial tumor (DNT), 11 cases of pleomorphic xanthoastrocytoma (PXA), 12 cases of epithelioid glioblastoma (E-GBM), and 13 cases of pilocytic astrocytoma (PA), 14 cases of papillary craniopharyngiomas (P-CPG) and 5 cases of adamantinomatous craniopharyngiomas (A-CPG). Immunohistochemical (IHC) staining was used to detect the expression of VE1 protein, which was divided into diffuse positive, single tumor cell positive, uniform " coating" positivity and negative according to the expression characteristics. The diffuse positive and single tumor cell positive results were interpreted as VE1 protein positive results (BRAF-V600E mutant), and the uniform " coating" positivity and negative results were interpreted as VE1 protein negative results (BRAF-V600E wild type). Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the type of BRAF-V600E. The accuracy of the IHC staining method for evaluating BRAF-V600E type was analyzed based on the results of RT-qPCR.

Among the 120 samples, IHC staining showed that VE1 protein was diffuse positive in 55 cases (45.8%), single tumor cell positive in 10 cases (8.3%), uniform " coating" positivity form in 20 cases (16.7%) and negative in 35 cases (29.2%). In 48 cases of GC/GGs, the above four expression features appeared in varying amounts, and all 14 cases of P-CPG were diffuse positive, and 5 cases of A-CPG were negative. All 10 cases of positive in single tumor cells were found in GC/GG. VE1 protein expression was positive in 65 cases and negative in 55 cases. The results of RT-qPCR showed that 67 of the 120 cases were BRAF-V600E mutant and 53 were wild type. Among them, the mutation rate of BRAF-V600E in GC/GG was 75% (36/48), the mutation ratio was 2/17 for DNT, 7/11 for PXA, 7/12 for E-GBM, and 1/13 for PA, and BRAF-V600E mutation was present in all 14 cases of P-CPG. BRAF-V600E mutation was absent in all 5 A-CPG patients. The consistency rate between IHC and RT-qPCR was 98.3% (118/120), among which 2 cases were uniform " coating" positivity.

The mutation rate of BRAF-V600E seems different in various brain tumors. The detection of VE1 protein by IHC staining is consistent with that by RT-qPCR for BRAF V600E mutation. However, there is a possibility of misjudgment for VE1 protein uniform " coating" positivity, and the final interpretation should be cautious, and further molecular pathology detection is recommended.

To explore the factors associated with the peripheral bone erosion in meningiomas and to investigate the relationship between bone erosion and patient prognosis.

A retrospective analysis was conducted on the clinical data of 198 patients with meningiomas in close contact with surrounding bone who were diagnosed and treated in the Department of Neurosurgery at the First Affiliated Hospital of Fujian Medical University from January 2020 to December 2021. The patients were divided into two groups based on the degree of tumor invasion into bone: the non-bone erosion group (149 cases) and the bone invasion group (49 cases). The clinical general data, imaging indicators, biochemical examination indicators, and pathological indicators of the two groups of patients were compared, and factors with statistical significance were included in a multivariate logistic model for further analysis. Follow-up of patients′ postoperative tumor recurrence was conducted, and the Kaplan-Meier method was used to calculate the progression-free survival rate of patients in both groups. The log-rank test was used to compare the differences in survival rate between the two groups.

The maximum diameter of the tumor and the diameter of peritumoral edema in the bone erosion group were both larger than those in the non-bone erosion group (both P<0.05), and the serum magnesium concentration in the bone erosion group was lower than that in the non-erosion group (P<0.05). The proportion of high-grade World Health Organization (WHO) classification in the bone erosion group was higher than that in the non-bone erosion group (P<0.05), and the positive expression rate of glial fibrillary acidic protein (GFAP) in the non-bone erosion group was higher than that in the bone erosion group (P<0.05). Multivariate logistic regression analysis showed that increased serum magnesium ion concentration (OR=0.01, 95%CI: 0.01-0.95) and negative GFAP expression in tumor tissue (OR=0.45, 95%CI: 0.21-0.96) were independent protective factors for meningioma bone erosion (both P<0.05). The patients were followed up for 40.66±6.45 months (30-53 months). Up to the last follow-up, a total of 6 patients had tumor recurrence, of which the recurrence rate was 0.7% (1/149) in the group without bone erosion and 10.2% (5/49) in the group with bone erosion. Progression-free survival analysis of 198 patients showed that the progression-free survival rate in the bone erosion group was higher than that in the non-bone invasion group, and the difference was statistically significant (P<0.001).

Increased serum magnesium levels and negative expression of GFAP in tumor tissue are independent protective factors for peripheral bone erosion in meningiomas. Patients with meningiomas with bone erosion have high recurrence rate and poor prognosis.

To investigate the role of indocyanine green video angiography (ICG-VA) in venous protection during resecting tumors in the central sulcus region.

The clinical data of 23 patients with tumors in the central sulcus region who underwent surgical treatment in the Department of Neurosurgery, the First Affiliated Hospital of Soochow University from January 2020 to October 2023 were retrospectively collected. Pathological examination showed 19 cases of meningioma, 2 cases of brain metastasis, and 2 cases of glioblastoma. ICG-VA FLOW800 technology was employed in all those cases to clarify the relationship between the tumor and the central sulcus vein before tumor resection, and to assess the patency of the central sulcus vein and peritumoral drainage vein before and after tumor resection. Degree of resection, surgery-related complications, and follow-up clinical and imaging outcomes were investigated. The clinical outcome was assessed using the Karnofsky performance status (KPS) score.

The tumors of 23 patients were completely resected under intraoperative microscope; the central sulcus vein and peritumoral drainage vein were anatomically preserved. ICG-VA FLOW800 analysis confirmed that the central sulcus vein reflux after tumor resection was smooth in 21 cases (91.3%), and the reflux was obstructed in 1 case; 1 case had peritumoral vascular occlusion and upper sagittal sinus reflux obstruction due to tumor compression before resection; after tumor resection, the central sulcus vein refluxed to the upper sagittal sinus and peritumoral venous blood flow was smooth. During the perioperative period, there was 1 case of rebleeding, 2 cases of muscle strength decrease, 1 case of pulmonary infection, 2 cases of epileptic seizure, and 1 case of recurrence requiring a second operation. The postoperative follow-up time M(Q₁, Q₃) was 20 (6, 36) months. At the final follow-up, 19 cases (82.6%) had a KPS score of 90, and 4 cases (17.4%) had a score of 60 to 80; 1 patient with metastatic adenocarcinoma had tumor recurrence requiring reoperation.

ICG-VA FLOW800 technology helps clarify the relationship between the tumor and the central sulcus veins during tumor resection in the central sulcus area, allowing for a more complete tumor resection while protecting the venous system.

To investigate the clinical imaging and pathological features of diffuse midline glioma (DMG) with H3K27 changes.

Clinical data of 21 patients with DMG combined with H3K27 changes were collected. CT, MRI and magnetic resonance spectroscopy (MRS) imaging were used for tumor imaging detection, immunohistochemical staining were used for pathological detection, and atopic kit was used for related gene detection.

Preoperative imaging results of the 21 patients showed that the tumors mainly occurred in the brain stem (8 cases), thalamus and lateral ventricle (7 cases) and other midline sites. The tumor tissue usually presented as nodular or flaky mass with unclear boundary, which showed isodensity (42.9%, 9/21), mixed density (23.8%, 5/21), slightly higher density (19.0%, 4/21), and slightly lower density (14.3%, 3/21) on CT. MRI showed slightly longer T1 mixed signals or long T1 signals, slightly longer T2 mixed signals or long T2 signals, FLAIR or DWI equal or high signals. After contrast enhancement, there were obvious annular (28.6%, 6/21), nodular (38.1%, 8/21), patchy enhancement (19.0%, 4/21). MRS analysis showed that 66.7% (14/21) patients showed significantly lower N-acetylaspartic acid (NAA) peak, higher choline (Cho) peak, lower creatine (Cr) peak, lower NAA/Cho, and lower NAA/Cr. Immunohistochemical staining showed that H3K27M staining was positive in all the 21 patients, and the nuclei of tumor cells were diffuse positive or " mottled" or " Mosaic" positive, and the corresponding H3K27Me expression was often missing or decreased. The expression of glial fibrillary acidic protein was positive in all 21 patients, and isocitrate dehydrogenase 1 was negative. In this study, 90.5% (19/21) of the patients had decreased or absent H3K27Me3 expression, 23.8% (5/21) of the patients had decreased alpha-thalassemia X-linked mutant retardation syndrome protein expression, 81% (17/21) of the patients had positive oligodendrocyte transcription factor 2 expression, and Ki-67 positive index was 1%-15%. Genetic testing revealed that 9.5% (2/21) of the patients had mutations in the epidermal grouth factor receptor gene and 9.5% (2/21) had deletions of the cyclin-dependent kinase inhibitor 2A gene.

DMG with H3K27 alteration have certain imaging characteristics in MRI T1, T2, FLAIR and DWI signals, and tumors show annular, nodular and lamellar enhancement after enhanced scanning, which is helpful for differentiating the disease. MRS imaging showed obvious characteristics. The combined detection of H3K27M and H3K27Me molecules can be used as an important means of clinical diagnosis.

To analyze the risk factors of delayed intracerebral hemorrhage (DICH) after ventriculo-peritoneal shunt (VPS).

Clinical data of 315 patients with hydrocephalus who underwent VPS treatment in the Neurosurgery Department of Henan Provincial People′s Hospital from January 2022 to March 2023 were retrospectively analyzed. They were divided into non-DICH group (271 cases) and DICH group (44 cases) according to whether DICH occurred after surgery. The important influencing factors for the occurrence of DICH were identified using univariate analysis and multivariate logistic regression analysis (input method).

There was a higher proportion of male patients in the DICH group than in the non-DICH group [75.00% (33/44) vs. 51.66% (140/271)], a higher proportion of patients with a history of smoking [36.36% (16/44) vs. 21.40% (58/271)], alcohol consumption [36.36% (16/44) vs. 18.82% (51/271)], cerebral oedema around catheter [70.45% (31/44) vs. 32.47% (88/271)] and postoperative severe cough [29.55% (13/44) vs. 6.27% (17/271)], and a greater range of systolic blood pressure [M(Q₁, Q₃)] [51 (37, 65) mmHg (1 mmHg=0.133 kPa) vs.41 (31, 55)mmHg] (all P<0.05). Multivariate logistic regression analysis showed that cerebral oedema around catheter (OR=6.07, 95%CI: 2.72-13.57, P<0.001), increased range of systolic blood pressure (OR=1.03, 95%CI: 1.01-1.05, P=0.014), postoperative severe cough (OR=6.67, 95%CI: 2.35-18.90, P<0.001) were all independent risk factors for the occurrence of DICH after VPS.

Patients with cerebral oedema around catheter, great fluctuations in systolic blood pressure and severe coughing after VPS have a higher risk of DICH.

To investigate the influence of vascular compression types on the effect of percutaneous balloon compression (PBC) treatment for primary trigeminal neuralgia (TN).

The clinical data of patients with primary TN who underwent PBC treatment at the Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2020 to September 2021 were retrospectively analyzed. The patients were divided into two groups based on the number and characteristics of the offending vessels for the trigeminal nerve identified by preoperative three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA). Patients with multiple or large vessel compression were defined as the complex group, while those with non-multiple or non-large vessel compression were defined as the simple group. The baseline data, preoperative and postoperative visual analogue scale (VAS) scores, recurrence rate, and interval from surgery to recurrence were compared between the two groups. The factors related to pain recurrence after PBC treatment for TN patients were explored using Kaplan-Meier survival analysis and multivariate Cox regression model.

A total of 384 patients were enrolled in this study. Among them, 184 (47.92%) were in the complex group, while 200 (52.08%) were in the simple group. There were no significant differences in age, gender, symptom side, pain-affected branches, or comorbidities between the two groups (all P>0.05). Compared with the simple group, the patients in the complex group had higher preoperative VAS pain scores (8.1±0.8 vs. 8.6±0.9), shorter time from initial onset of the disease to intervention ( 42.7±24.1 months vs. 34.5±16.8 months), and higher recurrence rate of pain within 2 years [7.5% (15/200) vs. 19.6% (36/184)] (all P<0.001). In addition, the recurrence rate of pain within 6 months was higher in the complex group than in the simple group [3.3% (6/184) vs. 0.5% (1/200)], as well as the recurrence rates within 6 months to 1 year [7.1% (13/184) vs. 2.5% (5/200)], 1-2 years [respectively 9.2% (17/184) vs. 4.5% (9/200)] (all P<0.05). The results of the multivariate Cox regression model analysis showed that the type of vascular compression being complex and a higher preoperative VAS pain score were associated with postoperative pain recurrence in patients (both P<0.05), while the age, gender, symptom side, pain-affected branches, comorbidities, and postoperative immediate VAS score were not significantly related to postoperative recurrence (all P>0.05). The log-rank test results showed that multi-branch vessel or large vessel compression was associated with earlier pain recurrence in primary TN patients (P<0.001).

Primary TN patients with non-multiple vessel and non-large vessel compression show better long-term therapeutic outcomes after PBC, while patients with multiple vessel and large vessel compression have a relatively higher risk of pain recurrence after surgery.

To explore the feasibility of ipsilateral C7 nerve transfer via a single-incision posterior cervical epidural approach through anatomical studies.

Five fresh cadaveric head and neck specimens were selected to simulate the ipsilateral C7 nerve transfer surgery via a single-incision posterior cervical epidural approach. Surgery-related anatomical markers and their relationships with surrounding structures were observed under a microscope, and relevant anatomical data were measured and analyzed.

The ipsilateral C7 nerve transfer surgery via a posterior cervical epidural approach was successfully completed in all five specimens. The vertical distance between the C7 nerve and the plane of the C7 transverse process was 2.6±0.3 cm (range: 2.3-3.0 cm), and the angle between the C7 nerve and the vertical line of the cervical vertebrae was 65.5±1.5 degrees (range: 63.0-67.5 degrees). The distal end of the C7 nerve root was separated into the anterior and posterior femurs, and the length of the C7 nerve root in the outer segment of the intervertebral foramen was 6.4±0.4 cm(range: 6.0-6.9 cm). The C7 nerve was introduced through the inner opening of the intervertebral foramen, and its length was 7.8±0.3 cm (range: 7.4-8.2 cm). The shortest distance for transfer of the C7 nerve through the epidural pathway was 3.3±0.3 cm (range: 3.0-3.6 cm).

Preliminary anatomical studies have demonstrated the feasibility of ipsilateral C7 nerve transfer via a single-incision posterior cervical epidural approach without the need for nerve grafting. This provides a theoretical basis for the feasibility of intraspinal epidural approach for C7 nerve transfer surgery.

To investigate the anatomical basis and feasibility of neuroendoscopic endonasal decompression for traumatic oculomotor nerve palsy.

Utilizing three dry skulls and six formalin-fixed adult Han Chinese cadaveric heads (excluding one with poor sphenoid sinus pneumatization), this study employed microscopes and neuroendoscopes to examine the superior orbital fissure and lateral sphenoid wall. The fissural segment was observed from multiple angles, and a simulated decompression of the orbital apex, superior orbital fissure, optic canal, and optic strut was performed under neuroendoscopic guidance.

On the dry skull, the medial margin of the superior orbital fissure was composed from top to bottom of the sphenoid wing, the lateral margin of the optic strut, part of the sphenoid body, and the maxillary strut. The oculomotor nerve divided into superior and inferior branches before passing through the superior orbital fissure and entered the orbit close to the bottom of the optic strut. Under both microscopic and endoscopic transnasal approaches, the optic strut was confirmed to be adjacent to the internal carotid artery, oculomotor nerve, and ophthalmic artery, highlighting the close relationship between the oculomotor nerve and the optic strut. In all six cadaveric specimens, sequential decompression procedures for the orbital apex, superior orbital fissure, optic canal, and optic strut were successfully simulated.

The oculomotor nerve is closely related to the optic strut; endoscopic transnasal approaches can be used to sequentially decompress the orbital apex, superior orbital fissure, optic canal, and optic strut, even when the sphenoid sinus pneumatization is poor.

To investigate the role of flexible electrode electrical stimulation in nerve injury repair after schwannoma surgery of the rat sciatic nerve.

A total of 27 male Sprague-Dawley rats weighing 200-250 g and aged 8-10 weeks were selected, of which 19 rats were used to establish a rat model of sciatic nerve injury post-schwannoma surgery, and 8 were used as healthy controls. Sciatic nerve tissue of three modeled rats was taken to detect the damaged nerve structure. The other 16 modeled rats were divided into stimulation group and non-stimulation group by randomization number table method (n=8 in each group). Flexible electrodes were implanted in the stimulation group for electrical stimulation treatment of the sciatic nerve for 2 weeks, while the non-stimulation group received only electrode implantation without stimulation; the healthy control group underwent no surgical procedure. At the end of the stimulation experiment, sciatic nerve tissue from each group was collected. HE staining, toluidine blue staining, immunohistochemistry, and immunofluorescence staining were used to assess nerve fiber arrangement, myelin sheath thickness, and the expression levels of markers associated with nerve regeneration to verify the effect of electrical stimulation on nerve repair. Simultaneously, RNA from the samples was extracted for high-throughput RNA sequencing to analyze immune cell infiltration, differential gene expression, and perform functional enrichment analysis of the differential genes.

HE staining indicated that the nerve fibers in the stimulation group were more densely arranged, with a structure closer to that of healthy control group, while the non-stimulation group showed significant fiber disorganization and signs of damage. Toluidine blue staining results suggested that electrical stimulation promoted myelin regeneration, with the myelin thickness in the stimulation group significantly increased compared to the non-stimulation group [M(Q₁, Q₃)][stimulation group: 2.59 (2.26, 2.76) μm, non-stimulation group: 0.41 (0.14, 0.86) μm, P<0.001]. Immunohistochemistry results demonstrated a notable upregulation in neurofilament medium (stimulation group: 3.96±0.65, non-stimulation group: 3.03±1.12, healthy control group: 1.58±0.53, F=16.13, P<0.001) and nerve growth factor expression [M(Q₁, Q₃)] [stimulation group: 1.29 (1.08, 1.36), non-stimulation group: 0.64 (0.57, 0.78), healthy control group: 0.76 (0.75, 0.87), H=6.14, P=0.047] in the stimulation group than the other groups (all P<0.05). Immunofluorescence staining showed a higher number of cells and elevated expression levels of neurofilament 200 and S100 protein in the stimulation group compared with the non-stimulation group (all P<0.001). High-throughput sequencing revealed that immune cell infiltration was higher in the non-stimulation group than in the stimulation and healthy control groups. Compared with the healthy control group, both the stimulation and non-stimulation groups showed higher immune infiltration and macrophage infiltration scores, with significantly higher M1 macrophage infiltration scores in the non-stimulation group than in the stimulation group (all P<0.05). Functional enrichment analysis indicated that the stimulation group showed significant enrichment in pathways related to nerve growth, such as cell adhesion assembly, negative regulation of the plasminogen system, and cytoskeletal regulation, and also enriched in the interleukin-6 signaling pathway and other inflammation-related pathways.

Flexible electrode electrical stimulation promotes nerve regeneration in sciatic nerve injury repair post-schwannoma surgery in rats by regulating inflammatory responses and other mechanisms.

To investigate the impact of TET methylcytosine dioxygenase1 (TET1) on the immune microenvironment of glioblastoma (GBM).

Using RNA-sequencing data from the China Glioma Genome Atlas (CGGA)(504 cases), The Cancer Genome Atlas (TCGA)(142cases), and 23 GBM samples obtained from Beijing Tiantan Hospital, samples were divided into TET1 high and low-expression groups respectively(the corresponding patient numbers for the three databases are 252 and 252, 70 and 72, and 12 and 11, respectively). Differentially expressed genes (DEGs) present in all three databases were selected for further analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed. The "xCell" tool was used to assess immune cell infiltration and to calculate immune score. Real-time quantitative PCR (RT-qPCR) and Western Blot (WB) were used to detect TET1 expression in stable TET1-konckdown GBM cell lines by shRNA (shTET1) and those transfecting negative control (shNC). Conditioned media from shNC and shTET1 GBM cells were co-cultured with U937 cell line, and flow cytometric analysis was used for detecting the proportion of M1 and M2 type macrophages polarized from U937, respectively. Additionally, RT-qPCR were used to analysis the expression of chemokine ligand (CCL2), Tryptophan 2, 3-Dioxygenase (TDO2), and Toll-like receptor 2 (TLR2), in shNC and shTET1 LN18 cell lines.

A total of 73 DEGs were screened out and co-existed in the above three databases, among which CCL2, TDO2, TLR2, and CD163 were the key nodes in the interaction network. GO and KEGG enrichment analysis showed that 73 DEGs were mainly involved in immune-related pathways. The " xCell" analysis showed that, compared with the TET1 low-expression group, the high-expression group showed a significant changes in B cell and macrophage infiltration in the TCGA and CGGA databases, while it merely showed a significant decrease in macrophage infiltration in the 23 GBM samples. Furthermore, compared with the TET1 low-expression group, immune scores and microenvironment scores were significantly decreased in the TET1 high-expression group in the CGGA and TCGA databases(all P<0.05). The results of RT-qPCR showed that the relative RNA expression of TET1 in shTET1 group 0.66±0.09 was lower than in shNC group 1.03±0.03(t=4.33, P=0.012). WB results showed that the relative protein expression of TET1 protein in shTET1 group 0.46±0.14 was lower than in shNC group 1.00±0.28 (t=2.73, P=0.042). The results of flow cytometry showed that the proportions of M1-type (13.97±0.37)% and M2-type (17.43±0.93)% macrophages induced by shTET1 GBM cells conditioned medium were significantly higher than those induced by shNC GBM cells conditioned medium [M1-type: (7.99±0.40)%, M2-type: (6.52±0.16) %] (both P<0.001). The RT-qPCR results showed that the relative RNA expression of CCL2, TDO2 and TLR2 in shTET1 GBM cells were 2.39±0.11, 1.65±0.07 and 2.05±0.07, respectively, which were higher than that corresponding shNC group (CCL2: 1.01±0.06, TDO2: 1.03±0.28, TLR2: 1.00±0.04; all P<0.05).

TET1 affects the infiltration of B cells and macrophages in the immune microenvironment of GBM. Inhibiting TET1 expression may promote M1 and M2 polarization of macrophages by regulating immune related genes CCL2, TDO2, and TLR2.

Brain abscess caused by Nocardia is extremely rare, difficult to diagnose early, and has a high mortality rate. Its treatment is still controversial. In July 2023, a patient with Nocardia brain abscess was admitted to the Department of Hematology, Affiliated Cancer Hospital of Shanxi Medical University. After 6 months of treatment with trimethoprim-sulfamethoxazole-based double antibiotics, the patient's original symptoms were relieved, the lesion disappeared, and there was no recurrence after 1 year follow-up. In addition, through literature review, the data of 28 reported cases of Nocardia brain abscess in China were summarized, and the risk factors, clinical features, treatment methods and prognosis of Nocardia brain abscess were analyzed.

Traumatic craniocerebral injury, as one of the diseases with the highest mortality and disability rate at present, has been confirmed to have significant endocrine function changes in its acute phase, which seriously increases the risk of adverse outcomes in patients. Therefore, it is of great significance to further elucidate the influence mechanism of traumatic craniocerebral injury on the endocrine system for targeted correction of endocrine disorders and improvement of patients' prognosis. This article systematically reviews the characteristics, specific mechanisms and clinical interventions of endocrine changes in the acute phase of traumatic craniocerebral injury, in order to provide theoretical basis for further improving the comprehensive management mode of traumatic craniocerebral injury in the acute phase under the guidance of "injury control theory" and improving the overall prognosis of patients.