Volume 41 · Issue 02 · 2025

Meningioma is the most common primary tumor of the central nervous system. Although most meningiomas are benign, their diagnosis and treatment still face many challenges. By integrating the multi-disciplinary collaborative diagnosis and treatment mode of surgery, radiology, pathology, radiotherapy, medical oncology, etc., all-round support for patient diagnosis, treatment and postoperative management can be realized, and the quality of diagnosis and treatment of meningioma can be improved. At the same time, the construction of a standardized diagnosis and treatment process will help to change the status quo of significant differentiation in meningioma diagnosis and treatment, promote the effective development of multidisciplinary collaboration, and promote the continuous optimization of the comprehensive diagnosis and treatment system of meningioma. This paper summarizes the current status of diagnosis and treatment of meningioma, discusses the necessity and clinical significance of multidisciplinary collaboration mode, and advocates the construction of a standardized diagnosis and treatment process system, in order to achieve accurate treatment and optimal management of meningioma.

Glioma is the most common primary intracranial malignancy in adults. The annual incidence of glioma in China is 5/100,000~8/100,000. The most malignant glioblastoma has a lower 5-year survival rate than pancreatic and lung cancer, and has the worst survival prognosis among systemic malignancies. Although the precise diagnosis and treatment of glioma has made significant progress in recent years, the overall prognosis of patients is still not optimistic. It is particularly important to formulate scientific and standardized indicators of medical quality control (referred to as quality control) for glioma patients to improve the clinical management of the whole course of glioma patients, thus improving the quality of life of patients and prolonging the survival time of patients. Against this background, the National Center for Medical Quality Control of Neurological Diseases approved the establishment of a neurosurgical glioma disease group on July 19, 2024, and organized domestic experts and scholars in the field of glioma to jointly compile the Medical Quality Control Index of Glioma (2024 Edition). This quality control index system covers many aspects such as diagnosis accuracy, rationality of treatment plan, evaluation of treatment effect, complication control, etc., aiming to comprehensively evaluate the whole process of glioma diagnosis and treatment in a quantitative form, provide strong data support for the management and continuous improvement of medical quality, and ensure the overall improvement of glioma diagnosis and treatment quality. According to the Guidelines for Diagnosis and Treatment of Brain Glioma (2022 Edition), the Guidelines for Integrated Diagnosis and Treatment of Brain Glioma of China Anti-Cancer Association (2024 Edition), and the Guidelines for Clinical Management of Brain Glioma in China (2022 Edition), the specific quality control indicators are as follows.

To investigate the effect of endovascular embolization of dural arteriovenous fistula (DAVF).

The clinical data of 6 patients with DAVF who underwent intravascular embolization at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from October 2016 to October 2021 were retrospectively analyzed. According to the whole-brain digital substraction angiography (DSA), venous fistula embolization was performed via simple transarterial approach or combined arterial and venous approach. The embolization degree of DAVF was evaluated by DSA immediately after surgery and about 12 mouths later, and the clinical outcome was evaluated according to the postoperative follow-up data.

Among the 6 patients, 3 cases were embolized by arterial approach and 3 cases by arterial combined with venous approach, the operations were all successful. Immediate postoperative DSA showed that 5 cases were completely embolized and 1 case was nearly completely embolized. All the 6 patients achieved clinical cure after surgery, and no serious neurological complications occurred after surgery. The median follow-up was 11.5 months (8-15 months). Postoperative DSA follow-up showed that DAVF was completely embolized in all 6 patients.

For the patients with DAVF in the large cerebral vein area, the embolization rates immediately and about 12 mouths after endovascular treatment with simple transarterial access and transarterial combined transvenous access are high and the the efficacy is good.

To investigate the effect of modified encephalo-duro-myo-synangiosis (EDAMS) on alleviating postoperative temporal depression in adult patients with Moyamoya disease.

This prospective study included adult patients with Moyamoya disease admitted to the Department of Neurosurgery at the First Affiliated Hospital of Kunming Medical University from January to July 2022. All patients underwent superficial temporal artery (STA) to middle cerebral artery (MCA) bypass combined with EDAMS. Using the Excel random selection method, patients were assigned to the modified surgery group and the traditional surgery group. The modified EDAMS procedure involved partial dissection of the superficial temporal fascia flap, whereas the traditional procedure did not include this modification. Temporal thickness on the surgical side was measured using cranial CT imaging, and cerebral perfusion was assessed via CT perfusion imaging (CTP). Preoperative and postoperative (3 months) temporal thickness and related perfusion parameters were compared between the two groups. All data were represented by M(Q₁, Q₃).

A total of 39 patients were included, with 21 in the modified surgery group and 18 in the traditional surgery group. There were no statistically significant differences in baseline clinical characteristics between the two groups (all P>0.05). The preoperative temporal thickness was 9.43±1.29 mm in the modified surgery group and 9.62(8.48, 10.55)mm in the traditional surgery group, with no significant difference (P=0.844). At 3 months post operation, the temporal thickness was 5.46 (4.44, 7.60) mm in the modified surgery group and 3.76 (2.58, 4.87) mm in the traditional surgery group. The changes in temporal thickness between preoperative and 3-month postoperative measurements were 3.60 (2.26, 4.24) mm and 5.49 (4.74, 6.12) mm in modified and traditional surgery groups respectively (both P<0.05). There were no significant differences between the groups in preoperative and postoperative CTP-related parameters (all P>0.05). Postoperative complications included transient speech dysfunction in 2 patients in the traditional surgery group, while no surgery-related complications occurred in the modified surgery group. At 3 months post operation, all bypass grafts remained patent, and cerebral perfusion was improved in both groups.

Modified EDAMS, while ensuring cerebral perfusion enhancement, effectively alleviates temporal depression in patients with Moyamoya disease, contributing positively to facial aesthetics.

To explore the safety and feasibility of endovascular embolization for anterior cerebral artery(ACA)-pericallosal artery (PA) aneurysms.

We retrospectively collected clinical data from patients who underwent endovascular embolization for ACA-PA aneurysms at the Department of Cerebrovascular Diseases, Qinghai Cardio-Cerebrovascular Hospital (12 cases) and the Department of Neurosurgery, the First Affiliated Hospital of Soochow University (6 cases) between September 2019 and December 2022. There were a total of 18 cases (19 aneurysms), of which 13 were ruptured aneurysms. Immediately following the procedure, whole-brain digital subtraction angiography (DSA) was performed to evaluate aneurysm visualization, and the Raymond-Roy embolization grading system was utilized to assess immediate postoperative embolization. Cranial CTA was conducted three months post-operation, while DSA or magnetic resonance angiography (MRA) was performed at 6 to 24 months post procedure to monitor for aneurysm recurrence and to assess any stenosis or occlusion in the stent and the parent artery. The Glasgow Outcome Scale (GOS) grade was administered one year after the procedure to evaluate the patients′ outcomes.

Endovascular treatment was successfully completed in 18 patients, comprising 11 cases of stent-assisted embolization and 7 cases of spring coil embolization alone. Seventeen patients presented with Raymond-Roy embolization grade Ⅰ, while one patient exhibited grade Ⅱ on immediate postoperative imaging. Four patients experienced perioperative complications.One patient experienced tube holding due to vascular spasm during surgery, which improved after spasmolysis treatment.One patient with a ruptured aneurysm experienced in-stent thrombosis following stenting. One patient with a ruptured aneurysm and a small hematoma in the corpus callosum prior to surgery showed slight enlargement of the hematoma on the first postoperative day after stent-assisted treatment. Two patients (one patient experienced tube holding during surgery) with ruptured aneurysms developed lung infections after surgery. All patients improved after symptomatic treatment. Cranial CTA was conducted in 18 patients at 3 months postoperatively, while DSA was performed in 16 patients at a median of 15.50 (13.25, 18.00) [M(Q₁, Q₃)] months post operation, and MRA was conducted in 2 patients at one year post operation. The imaging results indicated no recurrence of aneurysms, and there was no evidence of stenosis or occlusion in either the stent or the parent artery. At one year after the procedure, 17 cases achieved a GOS grade Ⅴ, and one case received a GOS grade Ⅳ.

Endovascular embolization has proved to be an effective treatment for ACA-PA aneurysms, and its has mild perioperative complications and low risk of recurrence in the short term after surgery.

To identify risk factors for intracranial arteriovenous malformation (AVM)-related hemorrhage and epilepsy in children.

This was a case-control study. The clinical data of pediatric patients (age <18 years old) diagnosed with intracranial AVM at Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2008 to April 2023 were retrospectively analyzed. The clinical manifestations, bleeding characteristics and AVM characteristics of the children were summarized, and possible risk factors for intracranial AVM-related hemorrhage and epilepsy in children were screened through univariate analysis, and factors with statistically significant differences (P<0.05) were included in multivariate logistic regression to identify independent risk factors for intracranial AVM-related hemorrhage and epilepsy in children.

A total of 138 pediatric AVMs with a follow-up period of 7.4±3.9 years (range: 1.0-15.9 years) were included. Among them, 80.4% (111/138) of the patients presented with intracranial hemorrhage only, 4.3% (6/138) with epilepsy only, and 5.8% (8/138) with both epilepsy and intracranial hemorrhage. Univariate analysis showed that the maximum diameter of AVM<3 cm and deep drainage alone were associated with AVM-related hemorrhage in children (P=0.001 and P=0.023, respectively), whereas age, gender, AVMs location, aneurysms presence, drainage vein dilatation, and the number of feeding arteries≥2 were not (all P>0.05). Only the maximum diameter of AVM<3 cm (OR=5.17, 95%CI: 1.79-14.92, P=0.002) was an independent risk factor for AVM-related hemorrhage, according to multivariate logistic regression analysis, while deep drainage alone was not (OR=3.14, 95%CI: 0.64-15.57, P=0.161). Both the maximum diameter of AVM≥3 cm and unruptured AVM were significantly associated with epilepsy (P=0.026 and P=0.003, respectively), which were also independent risk factors (OR=3.81, 95%CI: 1.19-12.18, P=0.024 and OR=4.27, 95%CI: 1.18-15.47, P=0.027, respectively). Age, gender, the location of AVMs, deep venous drainage, the location of hemorrhage, aneurysms presence, drainage vein dilatation, or the number of feeding arteries≥2 was not correlated with epilepsy (all P>0.05).

The maximum diameter of AVM<3 cm is a risk factor for AVM-related hemorrhage in children, while the maximum diameter of AVM≥3 cm and unruptured AVM are both risk factors for AVM-related epilepsy.

To investigate the relationship between the high tortuosity of internal carotid artery (ICA) from ophthalmic artery (OA) to posterior communicating artery (PCoA) and the formation of PCoA aneurysms and the correlation between the tortuosity of the vessel and hemodynamic parameters.

The clinical data of patients with PCoA aneurysm (aneurysm group, 43 cases) and without intracranial aneurysm (control group, 78 cases) who underwent digital subtraction angiography (DSA) examination in the Department of Neurosurgery, Shijiazhuang People′s Hospital from January 2017 to April 2020 were retrospectively analyzed and compared. The ICA-PCoA bifurcation apex was termed P₀, and the points located at the upstream of ICA, and 3 and 5 mm away from P₀ were named P_Up3 and P_Up5, respectively. The corresponding points located at the downstream were termed P_Dw3 and P_Dw5, respectively. The diameter and cross section area of upstream (D_Up and S_Up) and downstream (D_Dw and S_Dw) of ICA, the tortuosity from upstream to downstream (T_{(Up+ Dw)3} and T_{(Up+ Dw)5}, respectively), from P₀ to P_Up3 and P_Up5 (T_Up3 and T_Up5, respectively) and to P_Dw3 and P_Dw5 (T_Dw3 and T_Dw5, respectively) were measured based on the centerlines. Multivariate logistic regression and receiver operator characteristic (ROC) analysis were performed to identify the factors that associated with PCoA aneurysm presence and their predictive value. Seven vascular models with different tortuosity were designed to simulate the P₀ and its upstream and downstream of ICA segments, and to analyze the relationship between tortuosity and hemodynamic stresses based on the computational fluid dynamics (CFD).

Female and primary hypertension ratios, T_{(Up+ Dw)3}, T_{(Up+ Dw)5}, T_Up3, T_Dw3 and T_Dw5 of aneurysm group were significantly larger than control group (all P<0.05). The multivariate logistic regression analysis revealed that the female (OR=5.54, 95%CI: 2.20-13.50, P<0.001) and T_{(Up+ Dw)3} (OR=5.42, 95%CI: 2.24-13.13, P<0.001) were risk factors for the presence of PCoA aneurysm. ROC analysis showed T_{(Up+ Dw)3} had a medium predictive value for PCoA aneurysm presence with the area under the curve of 0.81. CFD analysis revealed significantly positive correlation between tortuosity and mean wall shear stress (WSS), pressure and vorticity magnitude of walls of seven models (r=0.94、0.92、0.94, respectively; all P<0.01).

The presence of PCoA aneurysm may be associated with female and the high tortuosity of ICA from OA to PCoA. The increase of mean WSS, pressure and vorticity magnitude of vascular walls are observed when arterial tortuosity is increased.

To investigate the preoperative factors affecting the improvement of quality of life of Parkinson′s disease (PD) patients by deep brain stimulation (DBS) of the subthalamic nucleus (STN), and to construct and validate a clinical nomogram prediction model for clinical decision-making.

This was a retrospective case-control study. A total of 102 PD patients who underwent bilateral STN-DBS at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, from January 2019 to June 2023 were included. The patients′preoperative clinical characteristics were analyzed and their clinical symptoms were assessed using motor and non-motor symptom evaluation scales. The Parkinson′s Disease Quality of Life Scale (PDQ-39) one year post operation was used to assess the patients′ quality of life. Based on whether their quality of life improved one year post operation, patients were divided into the improvement group and non-improvement group. Univariate and multivariate logistic regression analyses were performed to identify potential preoperative factors that might affect the patients′ quality of life. A nomogram model was constructed to predict postoperative quality of life in PD patients undergoing STN-DBS. The predictive performance of the model was evaluated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

Among the 102 patients, 68 were assigned to the quality of life improvement group and 34 to the non-improvement group. The preoperative PDQ-39 scores and preoperative Mini-Mental State Examination (MMSE) scores in the quality of life improvement group were significantly higher than those in the non-improvement group (both P<0.05). However, no significant differences were observed between the two groups in terms of surgical age, gender distribution, disease duration, daily levodopa equivalent dose (LED), preoperative International Parkinson and Movement Disorder Society Unified Parkinson′s Disease Rating Scale MDS-UPDRS-Ⅰ, MDS-UPDRS-Ⅱ, MDS-UPDRS-Ⅲ Med on, MDS-UPDRS-Ⅲ Med off, medication improvement rate, Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Montreal Cognitive Assessment (MoCA), or Voice Handicap Index (VHI) scores (all P>0.05). Multivariate logistic regression analyse revealed that preoperative PDQ-39 score (OR=1.070, 95%CI: 1.030-1.110, P<0.001), preoperative HAMD score (OR=0.817, 95%CI: 0.718-0.931, P=0.002), and preoperative MMSE score (OR=1.287, 95%CI: 1.048-1.581, P=0.016) were independent predictors of postoperative PDQ-39 score improvement in PD patients, whereas surgical age, disease duration, daily LED, preoperative MDS-UPDRS-Ⅰ, MDS-UPDRS-Ⅱ, MDS-UPDRS-Ⅲ Med on, MDS-UPDRS-Ⅲ Med off, medication improvement rate, HAMA, MoCA, or VHI score were not independent predictors of postoperative quality of life improvement (all P>0.05). The nomogram model constructed based on these factors demonstrated an area under the ROC curve of 0.757, with the calibration curve indicating good model fit. The model′s average absolute error was 0.08, and decision curve analysis showed that the model had high clinical utility.

Preoperative PDQ-39, HAMD, and MMSE scores are independent predictors of postoperative quality of life improvement in PD patients. The predictive model constructed based on these factors demonstrates good predictive performance and clinical applicability, and it can be used for preoperative assessment of patients′ expected quality of life improvement.

To investigate the clinical and pathological characteristics of lymphomatosis cerebri (LC).

This study retrospectively analyzed the clinical data of 13 patients diagnosed with LC via stereotactic intracranial lesion biopsy or craniotomy at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University between January 2019 and December 2023. Patient demographics, clinical presentations, imaging findings, cerebrospinal fluid (CSF) analysis, and pathological results were collected and summarized.

Among the 13 patients, the male-to-female ratio was 8 ∶5, with a median (Q₁, Q₃) age of 61 (51, 62) years. The most common clinical presentation was cognitive impairment (8/13), with cognitive impairment(4/13) and limb weakness(2/13) being the most frequent initial symptoms. MRI findings revealed diffuse and multiple intracranial white matter lesions in all 13 patients, involving both supratentorial and infratentorial regions. The lesions predominantly affected the deep white matter (13/13), cortical and subcortical white matter (12/13) and periventricular areas (11/13). On T1-weighted imaging, the lesions appeared as multiple hypointense or iso-hypointense signals, while T2-weighted imaging and T2 fluid-attenuated inversion recovery sequences demonstrated multiple hyperintense signals. Contrast-enhanced scans revealed no enhancement (10/13) or patchy enhancement (3/13). Preoperative fluorodeoxyglucose positron emission tomography/CT was performed in 9 patients, with a median (Q₁, Q₃) maximum standardized uptake value of 9.37 (8.20, 10.30). Increased metabolic activity was observed around the biopsy sites in 5 of the 8 evaluable patients. CSF analysis was conducted in 8 patients, revealing lymphocytes (8/8) and atypical cells (4/8) under microscopy. Elevated total cell counts and white blood cell counts were observed in 5 of 8 patients. Pathological diagnosis in all 13 cases confirmed diffuse large B-cell lymphoma, classified as non-germinal center origin according to the Hans model. Tumor cells frequently expressed B-cell markers, including CD20 (13/13), CD79α (12/13), multiple myeloma oncogene 1 (MUM1) (11/13), and paired box gene 5 (PAX5) (11/13), while CD3 and CD10 were negative. Glial cells commonly expressed glial fibrillary acidic protein (12/13) and oligodendrocyte transcription factor 2 (10/13). The Ki67 proliferation index exceeded 60% in 8 of 13 patients.

LC predominantly originates from B cells and is characterized by diffuse B-cell infiltration, often extending along nerve fiber tracts. Tumor cells consistently express CD20, CD79α, MUM1 and PAX5. LC should be considered a differential diagnosis in patients presenting with cognitive impairment and limb weakness, particularly when imaging reveals bilateral diffuse non-enhancing lesions.

To investigate the potential risk factors of delayed hyponatremia after transsphenoidal pituitary neuroendocrine tumor (PitNET) resection, and to establish and validate a prediction model.

The clinical data of 386 PitNET patients who underwent transsphenoidal surgery (TSS) at the Department of Neurosurgery of the Second Affiliated Hospital of Nanchang University from August 2017 to May 2023 were retrospectively analyzed. Patients were randomly assigned in a 7 ∶3 ratio to either the modeling cohort (271 patients) or the validation cohort (115 patients). The patients were divided into delayed hyponatremia group (hyponatremia group) and non-delayed hyponatremia group (control group) according to whether delayed hyponatremia occurred. In the modeling cohort, there were 33 cases in the hyponatremia group and 238 cases in the control group. In the validation cohort, there were 16 patients in the hyponatremia group and 99 patients in the control group. Univariate analysis and multivariate logistic regression model were used to analyze the data of the modeling cohort to evaluate the important influencing factors of postoperative delayed hyponatremia and to screen the predictive factors of the model. The programming software R (4.3.2) was used to make the nomogram based on logistic regression model. In the modeling cohort and validation cohort, the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the nomogram, the calibration curve was used to evaluate the fit degree of the prediction model to the ideal model, and the decision curve analysis (DCA) was used to evaluate its clinical application value.

In the modeling cohort, compared with the control group, the patients in the hyponatremia group had a larger preoperative tumor diameter, a higher proportion of tumors invading the cavernous sinus and suprasellar sinus, a lower serum sodium concentration on the first day after surgery, a higher proportion of patients with postoperative hypokalemia, a lower proportion of patients with postoperative diabetes insipidus, a larger preoperative pituitary stalk deflection angle, a larger postoperative pituitary stalk deflection angle difference and a larger sellar diaphragm subsidence depth. The differences were statistically significant (all P<0.05). Multivariate logistic regression model analysis showed that postoperative hypokalemia (OR=5.92, 95%CI: 2.22-15.77), a larger preoperative maximum tumor diameter (OR=1.08, 95%CI: 1.01-1.14) and pituitary stalk deviation angle difference (OR=1.05, 95%CI: 1.01-1.10) and sellar diaphragm sinking depth (OR=1.09, 95%CI: 1.01-1.19) were significant independent risk factors for postoperative delayed hyponatremia (all P<0.05). Diabetes insipidus (OR=0.13, 95%CI: 0.04-0.39) and high blood sodium concentration on the first day after surgery (OR=0.77, 95%CI: 0.66-0.91) were protective factors (both P<0.05).The area under the ROC curve (AUC) of the prediction model in the modeling and validation cohorts was 0.90 (95%CI: 0.85-0.96) and 0.88 (95%CI: 0.81-0.96), respectively. The Hosmer-Lemeshow goodness-of-fit test showed that the predicted risk of the model was highly consistent with the actual risk, and the model calibration was good (P values: 0.985 and 0.533 for the modeling cohort and validation cohort respectively). DCA curve showed that the net benefit of using this nomogram to predict delayed hyponatremia was high.

The occurrence of delayed hyponatremia after TSS in PitNET patients is related to the factors such as preoperative tumor maximum diameter, postoperative hypokalemia, postoperative diabetes insipidus, serum sodium concentration on the first postoperative day, greater difference of pituitary stalk deflection angle and greater subsidence depth of diaphragma sella. The constructed prediction model could help evaluate the probability of delayed hyponatremia after TSS in PitNET patients.

To explore the clinical efficacy of endoscopic neurosurgery for the resection of deep intracranial meningiomas.

A retrospective case series analysis was conducted on the clinical data of 26 patients with intracranial meningiomas who underwent minimally invasive neuroendoscopic treatment at the Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University from August 2019 to June 2024. Intraoperative neuronavigation and intraoperative ultrasound were used during operation. The extent of surgical resection was evaluated using the Simpson grading system. Postoperative follow-up primarily involved outpatient visits, supplemented by telephone and WeChat communications. MRI scans of the brain, including plain and enhanced images, were performed at 3 months postoperatively and annually thereafter to detect tumor recurrence. The efficacy during the follow-up period was assessed using the Karnofsky Performance Status (KPS) score.

Among the 26 patients, there were 27 tumors, with 15 located in the deep supratentorial region(2 tumors in one case) and 12 in the deep infratentorial region. The operation duration ranged from 160 to 368 minutes, with an average intraoperative blood loss of approximately 200 ml. All tumors were completely resected, with Simpson Grade I resection in 7 cases (26.9%) and Simpson Grade Ⅱ resection in 19 cases (73.1%). Pathological diagnosis was all meningiomas, including 24 cases of WHO grade 1 and 2 cases of WHO grade 2. Postoperative complications included 1 case of intracranial infection, 1 case of lung infection, and 1 case of hemiplegia. The patients with intracranial and lung infections were cured at discharge, and the hemiplegic patient recovered with normal muscle strength (grade Ⅴ) at the 1-month follow-up. No death occurred in the whole group. The median follow-up duration was 35 months (range: 1–59 months), with no recurrence cases observed. The KPS scores were 90 for 6 patients and 100 for 20 patients.

Neuroendoscopic surgery, combined with multiple adjuvant technologies such as intraoperative neuronavigation and ultrasound, could help achieve a high complete resection rate for deep intracranial meningiomas, with the advantages of minimal trauma and few complications. It is worthy of clinical promotion and application.

To investigate the application role of MRI image grayscale value in evaluating the tumor features and related nerve function of patients with cerebellopontine angle (CPA) tumors.

A retrospective analysis was performed on the clinical data of patients with CPA tumors who underwent surgical treatment in the Department of Neurosurgery, Renmin Hospital of Wuhan University from June 2019 to June 2023. We selected preoperative head enhanced MRI T1 sagittal images, and used ImageJ software to delineate the tumor area to obtain tumor area, maximum grayscale value, minimum grayscale value, and average grayscale value. According to the pathological classification of the patients′ tumors after surgery, they were divided into schwannoma (54 cases), meningioma (26 cases), epidermoid cyst (10 cases) and other tumors [glioblastoma (1 case), metastatic tumor (1 case), and chordoma (2 cases)]. House-Brackmann (H-B)grading was used to evaluate the facial nerve function of schwannoma patients and calculate the level of neurological decline (i.e. the difference between postoperative and preoperative H-B grades). Pearson or Spearman correlation coefficients was used to evaluate the correlation relationship among MRI image grayscale values, tumor areas and facial nerve function of the patients.Analysis of variance was used to investigate the differences in MRI image grayscale values between different pathological subtypes of tumors.

According to the pathological classification of tumors, the median area of tumors in 94 patients was 5.04(0.40-15.99)cm². Among them, schwannoma was 5.59±0.49 cm^2, meningioma was 5.12±0.61 cm², epidermoid cyst was 2.54±0.53 cm², glioma was 0.40 cm^2, metastatic cancer was 2.91 cm^2, and spinal cord tumors were 4.25 cm² and 6.18 cm². The maximum grayscale value, minimum grayscale value and average grayscale value, of tumors in 94 patients were 225.13±3.88, 58.44±4.07, and 172.78±5.48 respectively. The maximum grayscale value, minimum grayscale value, and average grayscale value of tumors in 54 schwannoma patients were 227.60±36.41, 49.17±32.00, 170.00±47.97 respectively. As for postoperative H-B classification of schwannoma patients, 17 cases were classified as grade Ⅰ, 14 cases as grade Ⅱ, 16 cases as grade Ⅲ, 6 cases as grade Ⅳ, 1 case not being evaluated because of comatose after surgery. After surgery, the H-B grade of 28 patients decreased (10 cases decreased by grade 1, 13 cases decreased by grade 2, 5 cases decreased by grade 3); 1 case improved by grade 1 ( decreased by grade -1); 24 cases showed no change (decreased by grade 0). The correlation analysis results showed negative correlation between the minimum grayscale value and tumor area (r=-0.28, P=0.007). There were no correlation between different schwannoma grayscale value and facial nerve function (all P>0.05).The analysis of variance results showed that there were no statistically significant difference in the grayscale values of MRI images among different pathological classification (all P>0.05).

The grayscale value of preoperative MRI images is related to the tumor area of the CPA area, which helps to assist in determining the degree of tumor progression of the CPA tumor, while the different grayscale value of schwannoma may not be related to facial nerve function.

To explore the application value of self-setting calcium phosphate bone cement (CPC) in cranioplasty during microvascular decompression (MVD) via the retrosigmoid approach.

This was a case-control study. A retrospective analysis was conducted on the clinical data of 127 patients who underwent MVD at the Department of Neurosurgery, Hebei Provincial People′s Hospital from April 2019 to February 2022. Among these patients, 11 had primary trigeminal neuralgia, 1 had glossopharyngeal neuralgia, and 115 had hemifacial spasm. A total of 63 cases underwent complete cranial bone repair using self-setting CPC (self-setting calcium phosphate group), while 64 cases underwent incomplete cranial bone repair using titanium mesh (titanium mesh group). The surgical outcomes were evaluated based on the surgical shaping satisfaction rate, length of hospital stay, and local pain and depression status at the 2-year postoperative follow-up. Postoperative complications, including the occurrence of cerebrospinal fluid leakage and intracranial infections, were also documented.

Compared with the titanium mesh group, the self-setting calcium phosphate group had a higher surgical shaping satisfaction rate [92.06% (58/63) vs. 78.13% (50/64)], shorter hospital stay (9.11±1.99 days vs. 10.61±2.75 days), and lower rates of local depression at the surgical site 2 years postoperatively [46.03% (29/63) vs. 71.87% (46/64)] and postoperative incision pain [7.94% (5/63) vs. 56.25% (36/64)]. The differences between the two groups were statistically significant (all P<0.05). The differences in the rates of cerebrospinal fluid leakage, intracranial infection, and lumbar puncture between the two groups were not statistically significant (all P>0.05). The proportion of intracranial infections diagnosed based on microbiological findings was lower in the self-setting calcium phosphate group compared to the titanium mesh group [1.59% (1/63) vs. 12.50% (8/64), P=0.017].

Compared with patients undergoing skull reconstruction with titanium mesh during microvascular decompression via the retrosigmoid approach, the use of CPC can improve surgical outcomes without increasing complications and is worthy of clinical promotion and application.

To explore the minimum mastoid osteotomy range required for the transpetrosal-presigmoid approach without contouring the semicircular canal and facial neural tube, and to study the effect of contouring on the surgical exposure area and surgical freedom.

Adult patients without craniosynostosis who underwent cranial CT angiography (CTA) examination were enrolled, and the cranial CTA data were imported into 3D Slicer software for three-dimensional reconstruction. The 3D Slicer software was used to label the Henle′s spine, the apex of the superior semicircular canal, the midpoint of the lateral semicircular canal, the anterior point of the posterior semicircular canal, the posterior point of the posterior semicircular canal, and the tip of the mastoid process in the three-dimensional reconstruction of the bony model of the 100 cases. The projected distances in the sagittal plane were measured between the line connecting the Henle′s spine with the tip of the mastoid process and the key points of the semicircular canal, and the minimum bony protection area of the semicircular canal and the facial nerve was determined. Five cadaveric head specimens (10 sides) were collected to simulate a conventional transpetrosal-presigmoid approach and mastoidectomy, and the projected distances in the sagittal plane of the line segments between key points, the anterior sigmoid sinus-exposed area and the inferotemporal-exposed area, and the degrees of surgical freedom were measured before and after contouring the semicircular canals (i.e., with and without removal of the protected areas).

The semicircular canals and the mastoid segments of the facial nerve were intact in all cadaveric head surgeries. There were no statistically significant differences between the measured projected distances on the sagittal plane from the three-dimensional reconstructions and the cadaveric specimens (all P>0.05). The area of anterior sigmoid sinus exposure before and after contouring semicircular canal was 151.63±32.77 mm² and 200.85±42.93 mm² respectively, the area of inferotemporal exposure before and after contouring semicircular canal was 113.12±53.10 mm² and 127.14±53.66 mm² respectively, the surgical freedom before and after contouring semicircular canal was 3 017.04±839.77 mm² and 4 392.56±906.60 mm² respectively, and the differences were statistically significant (all P=0.005).

The minimal mastoidectomy area defined in this study can protect the semicircular canal and the mastoid segment of the facial nerve without contouring the semicircular canal and the facial neural tube, while it would somewhat reduce the area of anterior sigmoid sinus and inferotemporal exposure and the degree of surgical freedom.

To investigate the key genes in the immune microenvironment of glioblastoma (GBM) and to analyze their roles in predicting the prognosis of GBM patients.

GBM single cell sequencing data in the Gene Expression Omnibus database were obtained, including a total of 91, 791 single cell sequencing results from 8 samples (including 4 GBM tissues and 4 para-cancerous tissues). Differential gene and Mendel randomization analysis was performed in combination with The Cance Genorne Atlas and the FinnGen R10-C3_GBM database to screen key genes of GBM immune microenvironment. CIBERSORT algorithm was used to study the immunological characteristics of key genes, and finally the value of key genes in prognosis prediction of GBM was analyzed by human protein library, single sample gene set enrichment analysis (ssGSEA) scores (samples were divided into high and low ssGSEA groups) and the nomogram prediction model.

The single cell data were analyzed and 21 cell subpopulations were obtained. The differential genes of GBM and adjacent tissues combined with Mendelian randomization analysis obtained 9 differential genes, among which 6 key genes had statistically significant expression differences at the transcriptomic level (all P<0.05), as follows: RHO family interaction cell polarization regulator 2 (RIPOR2), S100 calcium-binding protein A6 (S100A6), member H of the heat shock protein family 1 (HSPH1), member A of nuclear receptor subfamily 4 (NR4A1), ribonucleoprotein 10 (NOP10), and cytochrome B-245β chain (CYBB) gene. Among them, the high expression of CYBB, NOP10 and S100A6 genes was positively correlated with M2 macrophage infiltration, while it was negatively correlated with natural killer cell activation and M0 macrophage infiltration (all P<0.05). The high expression of HSPH1 and NR4A1 genes was positively correlated with M0 macrophage infiltration, while it was negatively correlated with M2 macrophage infiltration (all P<0.05). The high expression of RIPOR2 was positively correlated with neutrophil infiltration, and while it was negatively correlated with M2 macrophage infiltration (all P<0.05). CYBB gene was associated with infiltration of various immunosuppressive cells. 6 key genes were mainly enriched in angiogenesis, reactive oxygen species, transforming growth factor-β and hypoxia related pathways, cholesterol metabolism, apoptosis and rejection, complement and coagulation cascade. Further analysis showed that CYBB, HSPH1, NOP10, NR4A1 and S100A6 genes were highly expressed in GBM cells. Compared with the low ssGSEA group, the overall survival time, progression-free survival time and disease-specific survival time in the high ssGSEA group were decreased (all P<0.05). The nomogram prediction model based on six key genes showed good consistency in predicting 1-year and 3-year survival rates of GBM patients.

Immune-related genes S100A6, RIPOR2, NR4A1, NOP10, HSPH1 and CYBB are the key genes for infiltration and regulation of GBM immune cells. The integration of 6 key genes can help predict the prognosis of GBM patients.

Gliofibroma is a rare solid tumor with a biphasic histiocellular component of glial and mesenchymal cells. It is not listed as a single solid tumor in the current World Health Organization (WHO) classification of central nervous system tumors. In July 2023, a patient with intracranial space occupation was admitted to the Department of Neurosurgery of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology. After surgical resection, he was pathologically diagnosed as gliofibroma, which is equivalent to WHO central nervous system tumor grade 3. 86 days after surgery, MRI revealed that the tumor recurred and the size was similar to the initial mass. The patient and his family gave up further radiotherapy and chemotherapy, and temporarily received conservative treatment.

Scalp implant metastases after surgery for benign intracranial meningiomas are rare. In April 2024, a patient with scalp implant metastasis after meningioma surgery was diagnosed in the Department of Pathology, Yantaishan Hospital, Yantai City. The patient developed a subcutaneous mass at the surgical incision and gradually enlarged 3 months after surgery. He underwent "skin lesion tissue resection" in the neurosurgery department. After surgery, he was diagnosed as meningioma by pathology, World Health Organization Grade 1, which was in line with scalp implant metastasis after meningioma surgery. The patient recovered well after surgery and no recurrence was observed during the follow-up period.

Cerebral developmental venous malformation in children is a common clinical cerebrovascular malformation, but the incidence of combined thrombosis is low. This article retrospectively reports a child with cerebral developmental venous malformation complicated with thrombosis admitted to the Department of Neurosurgery of the Children's Hospital affiliated to Nanjing Medical University in January 2023. The child was given anticoagulant and antiepileptic therapy. The child recovered well and was followed up for 10 months without recurrence.

Brainstem glioma is a rare but highly malignant tumor of the central nervous system, and patients often have a poor prognosis. In addition to the typical neurological impairment, brainstem gliomas can lead to a complex set of cognitive and behavioral disorders such as attention deficit, impaired executive function, and aggressive behavior in patients. In recent years, neuroimaging techniques have revealed patterns of interaction between brainstem and cortical function, providing new insights into cognitive impairment. Cutting-edge basic research methods such as single cell sequencing and optogenetics are being used to further explore the molecular mechanisms by which brainstem gliomas trigger neuronal dysfunction. However, neuromodulation techniques such as transcranial magnetic stimulation and deep brain electrical stimulation have shown the potential to improve cognitive and behavioral disorders in patients with brainstem glioma. This paper aims to explore the neuropathological mechanisms of cognitive and behavioral disorders caused by brainstem glioma from macro to micro level, and discuss the application potential of neuromodulation techniques in its rehabilitation. The aim is to provide theoretical support for cognitive function protection and rehabilitation of patients with brainstem glioma before and after treatment.

The clinical application of neurosurgical robots represents the development level of neurosurgery in China to a certain extent. As an intelligent medical device, neurosurgical robots have developed rapidly in recent years and play an important role in a variety of operations. This paper briefly introduces the development history of domestic neurosurgical robots and some key technologies of their application, emphasizes the application of some robot models in clinical surgery, such as stereoscopic electroencephalogram, deep brain electrical stimulation, biopsy, etc., and makes a comparative analysis with traditional surgical methods, in order to provide reference for clinical application of domestic neurosurgical robots.

Glioma is the most common primary tumor of the central nervous system, with highly heterogeneous and highly variable survival rate. Traditional treatment methods still have limitations, so it is particularly important to find new treatment methods. Pan-apoptosis, as an important mechanism of cell death, has become one of the hotspots in the development, development and treatment of tumors in recent years. The purpose of this paper is to expound the research progress of pan-apoptosis in glioma, including its mechanism of action, regulatory factors, related signaling pathways and potential therapeutic strategies, in order to provide new ideas and strategies for the clinical treatment of glioma.