Volume 41 · Issue 04 · 2025

Vestibular schwannoma (VS) is a benign tumor originating from Schwann cells of the vestibular nerve. In recent years, with the advancement of imaging technology, VS can mostly be diagnosed early in the course of the disease; However, the optimal treatment plan for patients with small tumor size and mild neurological dysfunction remains controversial, and clinicians face many challenges in developing individualized treatment plans. The purpose of this article is to explore the diagnosis and treatment decision of small VS under the new technology condition.

To analyze the surgical treatment outcomes of 1 066 patients with acoustic neuroma in a single center, and to summarize the experience of diagnosis and treatment of acoustic neuroma.

The clinical data of 1 066 patients with acoustic neuroma treated by the same neurosurgeon in the Department of Neurosurgery, Xiangya Hospital, Central South University from January 2016 to January 2024 were retrospectively analyzed. The patient underwent standard screening procedures and was surgically treated. The operative method was microsurgical operation via the suboccipital retrosigmoid and its extended approach with the whole facial and cochlear nerve electrophysiological monitoring. In order to ensure the continuity, integrity and blood supply of facial nerve and cochlear nerve, the technique of uniform and sufficient decompression and bidirectional submembranous separation were adopted. Postoperative complications were documented and the extent of tumor resection was assessed by MRI. The patients were followed up at 6 months after surgery and annually thereafter. The facial nerve function of the patients was evaluated by House-Brackmann (H-B) grading system, grade Ⅰ-Ⅱ of H-B grading was defined as good facial nerve function, and hearing retention was evaluated by Gardner-Robertso (GR) hearing grading system, grade Ⅰ-Ⅲ of GR grading was defined as effective hearing.

Of 1 066 patients, 1 044 (97.94%) achieved complete resection and 22 (2.06%) achieved near-total resection to ensure facial or cochlear nerve integrity. The anatomical retention rate of facial nerve was 98.87%(1 054/1 066). Facial nerve function was good in 85.18%(908/1 066) of the cases. The anatomical retention rate of cochlear nerve was 71.20%(759/1 066) and the effective hearing retention rate was 68.86%(734/1 066). Postoperative complications included 4 cases (0.38%) of intraoperative hematoma, 2 cases (0.19%) of cerebellar swelling, 6 cases (0.56%) of cerebrospinal fluid leakage, 4 cases (0.38%) of posterior fossa epidural hematoma, 2 cases (0.19%) of postoperative visual acuity loss and 3 cases (0.28%) of other rare complications. There was no perioperative death. After 6 months, the facial nerve function was good in 89.77%(957/1 066) of the cases. Long-term follow-up follow-up time≥2 years of 768 patients showed that there were 7 cases (0.91%) of total tumor recurrence, among which the recurrence rate was 0.27% (2/752) after total resection and 5/16 after near-total resection, the difference was statistically significant (P<0.001).

The treatment of acoustic neuroma can achieve the maximum effect of total tumor resection and nerve function protection through standardized diagnosis and treatment process and several surgical methods such as in-situ separation of nerve and tumor.

To investigate the relationship between mesenchymal tumor-associated macro-phages (MES-TAMs) and malignant biological characteristics of gliomas.

Transcriptional data and clinical information from 693 glioma patients in the Chinese Glioma Genome Atlas (CGGA) database and 1 032 glioma patients in The Cancer Genome Atlas (TCGA) database were collected to analyze the correlation between MES-TAMs and the clinicopathological features of gliomas. Additionally, clinical information, exome mutations, and chromosomal copy number variations from 286 glioma patients in the CGGA database were collected. MES-TAMs scores for glioma tissues were calculated using gene set variation analysis (GSVA), and glioma samples were divided into high MES-TAMs score and low MES-TAMs score groups based on the median score. The relationship between MES-TAMs and the clinical, pathological and genomic characteristics of glioma patients was explored. Furthermore, the origin and functional pathways of MES-TAMs were analyzed based on the GSE131928 dataset. Kaplan-Meier curves were plotted to compare the survival differences between the high MES-TAMs score group and the low MES-TAMs score group.

Analysis of both the CGGA and TCGA databases showed that the MES-TAMs score increased with higher WHO tumor grades (both P<0.05). The MES-TAMs score was higher in IDH wild-type patients than in IDH mutant patients (both P<0.001). Patients with 1p/19q co-deletion had lower MES-TAMs scores than those without 1p/19q co-deletion (both P<0.001). Among the four TCGA molecular subtypes, mesenchymal glioma patients had the highest MES-TAMs scores (all P<0.001). The MES-TAMs score was higher in recurrent glioma patients than in primary glioma patients (P<0.001). MGMT promoter-methylated patients had lower MES-TAMs scores than non-methylated patients (P<0.001). In the analysis of 286 glioma patients from the CGGA database, those in the high MES-TAMs score group had higher age, higher proportion of glioblastoma (GBM), higher rate of chemotherapy treatment and greater tendency for gene mutation and chromosomal copy number variation compared with the low MES-TAMs score group (all P<0.05). Pathway enrichment analysis revealed that MES-TAMs were more likely to originate from bone marrow monocytes and closely associated with the hypoxic microenvironment and tumor necrosis factor. Survival analysis indicated that patients with high MES-TAMs scores had worse survival outcomes than those with low MES-TAMs scores in both overall gliomas and glioblastoma, as well as in both MGMT promoter-methylated patients and non-methylated patients(all P<0.05).

MES-TAMs are closely related to the malignant biological behavior of glioma and may serve as a potential therapeutic target for glioma treatment.

To explore the relationship between the prognostic models for glioblastoma patients based on MRI features and changes in molecular markers.

A total of 457 glioblastoma patients who underwent neurosurgery and were diagnosed by pathology at the Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2011 to January 2022 were retrospectively included and randomly divided into the training set (320 cases) and test set (137 cases) according to 7 ∶3. Based on the preoperative cranial MRI features, the imaging risk factors in the training set were screened using univariate and multivariate Cox regression analyses, and the prognostic prediction model was constructed based on Lasso regression and internally validated in the test set. Based on the prognostic risk scores calculated by the model, the patients were divided into high-risk and low-risk groups using the median value as the cutoff. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare differences in overall survival rates among patients in different risk groups. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the model for 2-year, 3-year and 5-year overall survival rates. Sixty typical molecular markers (including IDH1, EGFR, TERT, et al.) were collected in overall glioma tissues by second-generation sequencing and other techniques after surgery, and heatmaps of mutation distribution were plotted to compare molecular alterations in high-risk versus low-risk groups of patients in the overall sample.

The results of univariate Cox regression showed that the tumor was not in a single lobe of the brain, the involvement of functional areas, mixed T1 and enhanced signals, necrosis in the center of the tumor and increased diameter of the necrosis, multiple foci, hemorrhage, peritumoral oedema and increased distance of the oedema outgrowths were associated with short survival in patients with gliomas (all P<0.05). The results of multivariate Cox regression showed that tumor involvement in functional areas, T1 enhanced signals, multiple foci, and increased distance of peritumoral oedema were independent risk factors for short survival of glioma patients (all P<0.05). There were 106 patients in both the high-risk and low-risk groups with complete imaging features in the training set, and 42 patients in both the high-risk and low-risk groups in the test set. The log-rank test results showed that the overall survival rate of patients in the low-risk group was higher than that in the high-risk group in both datasets (both P<0.05). The prognostic model based on the above four risk factors was included in the ROC analysis, and the AUC values of 2-year, 3-year and 5-year overall survival in the training set were 0.835, 0.833 and 0.803 respectively, and 0.727, 0.713 and 0.798 in the test set respectively, which showed good predictive efficacy. Among the overall patients, there were 78 cases in the high-risk group and 79 cases in the low-risk group with molecular change information. Compared with the low-risk group, the proportion of patients with CDK6, CDKN2A, CDKN2B, FGFR2, FGFR3, MET, MYB, MYBL1, NOTCH1, PDGFRA, and RB1 gene mutations was higher in the high-risk group, while the proportion of patients with ATRX, CIC, and IDH1 gene mutations was lower (all P<0.05). The differences of the remaining molecular alterations were not statistically significant (all P>0.05).

The prognostic model for glioblastoma patients constructed based on MRI features has good predictive efficacy and is associated with changes in multiple molecular markers.

To investigate the risk factors of meningioma recurrence after operation.

A retrospective analysis was conducted on the clinical data of 142 patients who underwent surgical treatment and were confirmed to have meningiomas by postoperative pathological results at the Department of Neurosurgery, Peking University Third Hospital from January 2021 to June 2024. The extent of tumor resection was evaluated by Simpson classification. Taking tumor recurrence within 1 year after surgery as the primary outcome index, the patients were divided into recurrence group and non-recurrence group. Univariate analysis was performed on the clinical, imaging and pathological characteristics of the two groups of patients, and the factors with statistical significance (P<0.05) in univariate analysis were included in multivariate logistic regression model analysis to determine the independent risk factors for postoperative recurrence of meningioma.

Among the 142 patients, there were 16 cases (11.3%) in the recurrence group and 126 cases (88.7%) in the non-recurrence group.The results of univariate analysis showed that the age, proportion of female patients and WHO grade were higher in the recurrence group than in the non-recurrence group, and the degree of tumor resection was lower in the recurrence group, tumors located near the falx cerebri of the sagittal sinus were more common in the recurrence group, and the differences between the two groups were statistically significant (all P<0.05). There was no significant difference in pathological classification between the two groups (P>0.05). Multivariate logistic regression analysis showed that age ≥60 years (OR=10.760, 95%CI: 1.062-108.983, P=0.044), Simpson Ⅱ-Ⅲ resection (OR=14.135, 95%CI: 1.776-112.515, P=0.012) and tumor located in sagittal sinus and falx cerebri (OR=12.875, 95%CI: 1.135-92.384, P<0.001) were independent risk factors for postoperative recurrence of meningioma, while gender or tumor pathological classification were not independent risk factors for postoperative recurrence of meningioma (both P>0.05).

Patients with meningioma with age ≥60 years, tumor located in the sagittal sinus and falx cerebri, and Simpson Ⅱ-Ⅲ resection have a higher risk of postoperative recurrence.

To explore the clinical characteristics, treatment strategies, and prognosis of pediatric cervicomedullary brainstem gliomas.

A retrospective analysis was conducted on the clinical data of 10 children with cervicomedullary brainstem gliomas treated in the Department of Neurosurgery, Children′s Hospital of Soochow University from April 2019 to June 2023. All children underwent tumor resection via suboccipital midline approach under neurophysiological monitoring. The extent of tumor resection, postoperative complications, and pathological results were observed. Follow-up included evaluation of adjuvant treatment, survival status, tumor recurrence, and outcomes.

Among the 10 children (7 boys and 3 girls), the median age at presentation was 5 years and 8 months (range: 2 years to 14 years and 4 months). Total tumor resection was achieved in 1 case, near-total resection in 1 case, and subtotal resection in 8 cases. Postoperatively, 1 child developed facial palsy and bulbar palsy, and another child experienced progressive worsening of hydrocephalus compared with preoperative conditions. Pathological examination confirmed pilocytic astrocytoma in 3 cases and ganglioglioma in 7 cases. Four children with subtotal resection received adjuvant drug therapy, while 6 were followed up with observation. The median follow-up duration was 15.5 months (range: 9.0 to 59.0 months), during which all 10 children survived. Imaging follow-up showed that tumors in the 2 children who received postoperative chemotherapy had decreased in size to varying degrees, and no significant tumor recurrence was observed in the other 8 children. One child experienced progressive worsening of cervical scoliosis compared with preoperative conditions. The Barthel index rating scale scores was 83.5±16.1 points (50-100 points).

Cervicomedullary brainstem gliomas in children are predominantly low-grade in pathology. Local tumor resection under neurophysiological monitoring is associated with good short-term prognosis.

To summarize the clinical diagnostic characteristics of acquired immunodeficiency syndrome(AIDS)-related central nervous system(CNS) space-occupying lesions, and to explore the role of surgical intervention in the diagnosis.

We retrospectively collected clinical data of patients with AIDS-related CNS space-occupying lesions who underwent surgical procedures for diagnosis and/or treatment at the Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University from June 2013 to December 2020. The general clinical characteristics were summarized. The information about laboratory test, neuroimaging and pathology results was prepared for further analysis. The differences in laboratory examination and imaging characteristics were compared among patients with different pathological types with clear diagnosis and the number of ≥3 cases.

A total of 98 patients were included, with the male/female ratio of 91/7. The age was 38.0±11.9 years old (16-69 years old), the viral load of human immunodeficiency virus (HIV) in plasma [M(Q₁, Q₃)] was 95 355.6(57.8, 626 690.5) copies/ml. Forty-nine patients underwent surgical resection and biopsy. Through pathological examination after surgery, 34 (34.7%) patients were diagnosed with primary central nervous system lymphoma (PCNSL), 31 cases with viral infection [31.6%, including 28 cases of progressive multifocal leukoencephalopathy (PML), 2 cases of Epstein Barr virus (EBV) encephalitis, and 1 case of herpes simplex virus (HSV) encephalitis], 13 cases with tuberculosis (13.3%), 9 cases with toxoplasmosis encephalitis (9.2%), 4 cases with brain abscess (4.1%), 1 case with fungal infection (1.0%), and 6 cases with unclear diagnosis (6.1%). The most common neurological symptom was local muscle weakness (34.7%, 34/98), followed by headache (27.6%, 27/98). Among laboratory test results of PCNSL, PML, toxoplasma encephalitis, tuberculosis and brain abscess patients, there were no significant differences in plasma HIV viral load, expression levels of CD4⁺ T lymphocytes, CD8⁺ T lymphocytes, white blood cells, neutrophils, lymphocytes, erythrocyte sedimentation rate in peripheral blood samples, or glucose, total cells, white blood cells, chloride in cerebrospinal fluid samples (all P>0.05). However, there were significant differences in the levels of C-reactive protein in peripheral blood and the level of cerebrospinal fluid protein (both P<0.05). Among them, the cerebrospinal fluid protein of PCNSL and toxoplasma encephalitis patients was significantly higher than the other three types (all P<0.05). For neuroimaging parameters, the differences in apparent diffusion coefficient (ADC) values, number of lesions, and involvement of brainstem, basal ganglia, frontal lobe, temporal lobe, and insula among the five types of patients mentioned above were statistically significant (all P<0.05). The ADC values of PCNSL were lower than those of other types. In PCNSL, tuberculosis and PML cases, the proportion of patients with multiple lesions was higher than that of other types. The proportions of PML patients with lesions involving the brainstem, basal ganglia, frontal lobe, temporal lobe, and insula were higher than other types (all P<0.05).

AIDS-related CNS space-occupying lesions have various types and different clinical, laboratory and neuroimaging characteristics. Surgical intervention, including biopsy, is helpful in making clear diagnoses.

To investigate the early postoperative facial nerve movement and sensory function, as well as the factors affecting facial nerve movement function, after acoustic neuroma resection via the retrosigmoid sinus approach under the occiput.

A retrospective analysis was conducted on the clinical data of 172 patients with acoustic neuroma who underwent subpial resection via retrosigmoid approach in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023. The preoperative facial nerve function of all patients was House-Brackmann (H-B) grade Ⅰ, and intraoperative neurophysiological monitoring was performed in all cases. The postoperative facial nerve function was evaluated using the H-B grading system at discharge and 6 months after surgery, with H-B grades Ⅰ and Ⅱ defined as good function and grades Ⅲ to Ⅵ defined as poor function. Univariate and multivariate logistic regression analyses were used to explore the factors affecting the short-term postoperative facial nerve function. Simultaneously record postoperative nerve sensory (intermediate nerve) function during follow-up.

All surgeries were successfully completed in the 172 patients. Total tumor resection was achieved in 154 cases (89.5%), and near-total resection in 18 cases (10.5%). Eighteen patients (10.5%) developed postoperative complications, including 15 cases of intracranial infection, 3 cases of aspiration and 2 cases of diplopia. There were no cases of intracranial hemorrhage, cerebrospinal fluid leakage, or death. At discharge, 88 patients (51.2%) had good facial nerve movement function, and 84 patients (48.8%) had poor facial nerve movement function. All 172 patients were followed up clinically, including 152 patients (88.4%) with good facial nerve movement function and 20 patients (11.6%) with poor facial nerve movement function; 16 patients(9.3%) of intermediate nerve dysfunction occurred, among which 5 patients (2.9%) developed decreased taste sensation, 7 patients (4.1%) developed dry eye syndrome, 4 patients (2.3%) developed crocodile tear syndrome. 16 patients (9.3%) developed sensory disturbances in the occipital incision area. No cases of tumor recurrence were observed. The results of univariate logistic analysis showed that the facial nerve function of patients at discharge was related to their age ≥50 years, Koos grade, cerebrospinal fluid cleft sign, and tumor extension anterior to the internal auditory canal (all P<0.05). The results of multivariate logistic regression analysis showed that age ≥50 years was an independent risk factor for facial nerve movement function at discharge (OR=2.041, 95%CI: 1.045-3.984, P=0.037). Both univariate and multivariate logistic regression analyses showed that the facial nerve function movement at 6 months after surgery was not related to gender, age ≥50 years, maximum tumor diameter, T2 flow void, tumor cystic change, Koos grade, cerebrospinal fluid cleft sign, tumor extension anterior to the internal auditory canal, or the degree of tumor resection (all P>0.05).

Subpial resection of acoustic neuroma via the retrosigmoid approach, combined with intraoperative neurophysiological monitoring and neuroendoscopy techndogy, can maximize the protection of facial nerve function, while there still would be residual dysfunction of the intermediate nervous system. Age ≥50 years is an independent risk factor affecting early postoperative facial nerve function.

To evaluate the safety and efficacy of flow diverter (FD) in the treatment of basilar artery trunk aneurysms.

The clinical data of patients with basilar trunk aneurysms who were treated with FD in the Cerebrovascular Department of Interventional Center, People′s Hospital of Zhengzhou University (Henan Provincial People′s Hospital) from September 2018 to November 2023 were retrospectively analyzed. A total of 41 patients (41 aneurysms) were included. Adverse events that occurred during perioperative period and follow-up period of the patients were documented. Clinical follow-up was conducted through outpatient visits or telephone at 1, 6 and 12 months after surgery and annually. Modified Rankin Scale (mRS) was used to evaluate the outcomes of neurological functions. A good outcome was defined as an mRS score ≤ 2, and a poor outcome was defined as an mRS score>2. Imaging follow-up was carried out at 6 months and 12-24 months after surgery, and the O′Kelly-Marotta (OKM) grading scale was used to evaluate the healing status of aneurysms. Patients were divided into a complication group and a non-complication group according to the occurrence of complications, and factors that may affect the occurrence of complications were analyzed.

A total of 45 FD were used for 41 aneurysms, among which 4 aneurysms were treated with the overlapping FD placement technique. Among the 41 patients, 16 cases (39.0%) were combined with coil embolization treatment, and 4 cases (9.8%) were combined with the occlusion of unilateral vertebral artery. The operation time [M(Q₁, Q₃)] was 135.0 (87.5, 195.0) minutes. The incidence of perioperative complications after surgery was 19.5% (8/41), and the incidence of neurological complications was 17.1% (7/41); among them, there were 6 cases of ischemic complications, 1 case of aneurysm re-rupture and 1 case of gastrointestinal bleeding. One patient died during the perioperative period. At discharge, there were 31 cases with the mRS score of 0, 5 cases with the score of 1, 1 case with the score of 2, 1 case with the score of 4, 2 cases with the score of 5, and 1 case with the score of 6. Forty patients received clinical follow-up, and the follow-up time [M(Q₁, Q₃)] was 24 (12, 34) months. At the last follow-up, there were 33 cases with the mRS score of 0, 5 cases with the score of 1 and 2 cases with the score of 4. The overall rate of good outcome was 92.7% (38/41). Thirty-one patients completed imaging follow-up, and the follow-up time [M(Q₁, Q₃)] was 6 (6, 10) months; among the 31 aneurysms, 16 (51.6%) were classified as OKM grade D, 9 (29.0%) as grade C and 6(19.4%) as grade B. One patient was found to have asymptomatic parent artery occlusion at 6 months post surgery. Compared with the non-complication group, the complication group had higher proportion of patients with preoperative aneurysm rupture (3/8 vs. 3/33, P=0.019); while there were no statistically significant differences in gender, age, past medical history or other aspects between the two groups (all P>0.05).

The FD treatment for patients with basilar trunk aneurysms can better occlude aneurysms, and has acceptable safety, and the patients have good prognosis. However, attention should be paid to the occurrence of ischemic complications.

To explore a method combining cerebrospinal fluid(CSF) drainage test and CSF infusion test for predicting the efficacy of shunt surgery for possible idiopathic normal pressure hydrocephalus (iNPH).

A retrospective analysis of clinical data of 192 cases of possible iNPH patients admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2021 to December 2022. All paitents underwent lumbar puncture CSF drainage test and CSF infusion test. According to the positive results of lumbar puncture CSF drainage test, CSF infusion test, lumbar puncture CSF drainage test combined with CSF infusion, CSF shunt operation was performed. After 12 months of follow-up, patients were divided into shunt-responsive group and shunt-unresponsive group according to the improvement of clinical symptoms. The differences in baseline data and treatment results between the two groups were analyzed. The improvement of clinical symptoms after shunt was compared among three regiments. Modified Rankin Scale (mRS) was used to evaluate the outcomes of the patients, with the mRS score of 0-2 being defined as good outcome and 3-6 as poor outcome. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to analyze the effectiveness of three trial protocols in predicting CSF shunt surgery, and the Youden index was calculated to obtain the best cerebrospinal fluid outflow resistance (Rout) value.

Among 192 patients with iNPH, 136 were positive by lumbar puncture CSF drainage and/or infusion tests, and 79 of them underwent CSF shunt surgery. There were 59 cases in shunt-responsive group and 20 cases in shunt-unresponsive group. There were no significant differences in gender, age, past history, clinical symptoms, frontal lobe function assessment score, simple mental state test score, or 10-meter walk test (step number and time) between the two groups (all P>0.05). Compared with the shunt-unresponsive group, the duration of symptoms in the shunt-responsive group was shorter, and the scores of iNPH scale, international incontinence consultation questionnaire and Rout values were higher (all P<0.05). The 12-month follow-up showed that the improvement rates of clinical symptoms after shingles of the three schemes were 89.29% (50/56), 85.25% (52/61) and 81.43% (57/70) respectively, with no significant difference (χ²=1.51, P=0.470). The good outcome rate was 73.42% (58/79) and the poor come rate was 26.58% (21/79). The sensitivity (96.61%) and negative predictive value (77.78%) of lumbar puncture CSF drainage test combined with CSF infusion test were higher than those of lumbar puncture CSF drainage test (84.75% and 60.87%) and CSF infusion test (88.14% and 61.11%). ROC curve results showed that the optimal Rout threshold for predicting the effectiveness of CSF shunt surgery was 13.42 mmHg·min^-1·ml^-1(1 mmHg=0.133 kPa), AUC was 0.775, sensitivity was 81.00%, specificity was 73.30%, and the maximum approximate entry index was 0.543 (P<0.001).

The combination of lumbar puncture CSF drainage and infusion tests to predict the effectiveness of iNPH shunt surgery could improve the negative predictive value and sensitivity, reduce false negative results, and seems superior to a single test scheme. CSF infusion test Rout≥13.42 mmHg·min^-1·ml^-1 suggests that iNPH patients would benefit after shunt surgery.

To explore the effect of susceptibility weighted imaging (SWI) in visualizing and locating the subthalamic nucleus (STN) during deep brain stimulation (DBS) in Parkinson′s disease (PD).

The clinical and imaging data of 20 PD patients who underwent bilateral STN-DBS in the Department of Neurosurgery, Affiliated Hospital of Nantong University from September 2022 to January 2024 were retrospectively analyzed. All patients underwent 3T MRI scans before surgery. The layer with the largest STN area was selected on the coronal SWI, and the target was set near the ventral border of the STN. During surgery, electrodes were implanted according to the dorsal and ventral electrophysiological borders of the STN identified by microelectrode recording (MER). Postoperative CT was performed and fused with the preoperative MRI. Patients were followed up in the outpatient clinic 3 months after surgery, and the Unified Parkinson′s Disease Rating Scale (UPDRS)-Ⅲ scores were evaluated in the on-medication + on-stimulation state and in the off-medication + off-stimulation state, and the improvement rate of the UPDRS-Ⅲ score was calculated. Two neurosurgeons visually evaluated the clarity of bilateral STN on SWI and T2WI (n=40), and calculated the contrast-to-noise ratio (CNR) of STN relative to the zona incerta and substantia nigra on the two sequences to compare the clarity of STN on MRI. The distances between the planned target and the dorsal and ventral borders of STN were measured on coronal T2WI and SWI, respectively. The border errors between MRI-STN and MER-STN were calculated to evaluate the accuracy of the two sequences in locating the STN.

Typical electrophysiological activity of STN was recorded in all 20 patients, and no intracranial hemorrhage occurred after surgery. The fusion images of postoperative CT and preoperative MRI indicated that the electrode positions were basically consistent with the preoperative plan. Three months after surgery, the UPDRS-Ⅲ score of the 20 patients in the on-medication + on-stimulation state was 26.5±9.0, and the score in the off-medication + off-stimulation state was 56.7±9.9, and the improvement rate was 52.71±14.52%. Compared with T2WI, the visualization scores of STN (2.7±0.3 points vs. 1.5±0.4 points), CNR of STN relative to substantia nigra [M(Q₁, Q₃): 2.5 (1.4, 3.8) vs. 0.5 (0.3, 0.6)] and CNR of STN relative to zona incerta [M(Q₁, Q₃): 5.1 (3.9, 7.5) vs. 1.9 (1.3, 2.4)] were significantly higher on SWI (all P<0.001). There was no significant difference in the errors of dorsal or ventral MRI-STN or MER-STN borders between SWI and T2WI (both P>0.05).

The clarity of visualizing and locating the STN in PD by 3T SWI is superior to that of T2WI, while the accuracy of locating the dorsal and ventral borders of STN is comparable to that of T2WI.

To explore the predictive role of intraoperative lateral spread response (LSR) in the efficacy of microvascular decompression (MVD) surgery for patients with hemifacial spasm (HFS).

A retrospective analysis was conducted on the clinical data of 205 patients with HFS who underwent MVD at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University between November 2020 and August 2022. All patients underwent intraoperative LSR monitoring. The relationship between the disappearance of LSR and the patients′ outcomes was assessed at 7 days and 1 year postoperatively. Complete and near-complete recovery were defined as " cured", while partial relief and no effect were considered " non-cured" .

Among the 205 patients, LSR disappeared in 151 cases (73.7%) and remained in 54 cases (26.3%). At 7 days and 1 year postoperatively, the cure rate was 83.4% (126 cases) and 97.4% (147 cases) in the LSR disappearance group respectively. In the LSR non-disappearance group, the cure rate was 57.4% (31 cases) at 7 days and 70.4% (38 cases) at 1 year. The differences in the cure rates between the two groups were statistically significant at both time points (both P<0.001). At 1 year postoperatively, 185 patients (90.2%) were cured, and 20.5% (38 cases) of them had persistent LSR. Among the 20 patients (9.8%) who were not cured, 80.0% (16 cases) had persistent LSR. The difference was statistically significant (χ²=32.887, P<0.001). Multivariate logistic regression analysis revealed that the persistence of LSR during MVD was an independent risk factor for poor postoperative prognosis in HFS patients (OR=15.015, 95%CI: 4.810-58.515, P<0.001).

Monitoring of intraoperative LSR during MVD surgery can help predict the therapeutic outcomes of patients with HFS.

To preliminarily observe the effect and safety of endovascular treatment for vertebral artery arteriovenous fistulas (VAVF).

A retrospective analysis was conducted on the clinical data of 6 patients with VAVF who underwent endovascular treatment at the Neurovascular Center, the First Affiliated Hospital of Naval Medical University from January 2012 to December 2020. Four cases were treated with vascular reconstructive methods, including one case using a covered stent, and three cases using balloons assisted with coils and Onyx embolic agents to embolize the fistula (in one of which combined stent placement was applied), while preserving the integrity and patency of the affected vertebral artery during operation. The other two cases used a combination of coils and Onyx embolic agents to embolize the fistula and the proximal end of the parent artery. All patients underwent digital subtraction angiography (DSA) immediately after surgery to assess the degree of occlusion in VAVF. Outpatient or telephone follow-up was conducted at 3, 6, 12, and 24 months after surgery, with magnetic resonance angiography (MRA) or DSA examinations performed to analyze the symptom changes and determine the modified Rankin Scale (mRS) score.

Among the 4 patients who underwent constructive treatment, 2 cases showed immediate disappearance of the fistula on DSA after operation, with unobstructed blood flow in the distal vertebral artery and symptom relief. Two cases showed a decrease in VAVF and symptom relief on DSA immediately after surgery, and a 9-month DSA follow-up post operation showed disappearance of the fistula, but 1 case had parent vertebral artery occlusion. Among the two patients who did not undergo vascular construction, one patient underwent endovascular embolization treatment and immediately showed disappearance of the fistula on DSA. However, on the second day, VAVF recurred and the fistula disappeared after another endovascular embolization treatment. One case underwent staged intravascular embolization, and the fistula disappeared after the second operation. None of the 6 patients experienced treatment-related complications after operation or during follow-up. Five patients were followed up for 2 years, one patient was followed up for 1 year, and none of the six patients had recurrence of symptoms. The DSA results showed no recurrence of VAVF with mRS score of 0, indicating imaging cure at last follow-up.

Intravascular treatment can effectively occlude VAVF with good safety. Choosing vascular reconstructive method can help with preserving the affected vertebral artery.

To investigate the role and mechanisms of a novel skull repair material based on blue light-cured hydrogel in the repair of cranial defects.

A total of 24 Sprague-Dawley rats (200-250 g, 9-10 weeks old) were randomly divided into the healthy control group (n=8), non-hydrogel group (n=8), and hydrogel group (n=8). The healthy control group did not receive any treatment; The left parietal bone (5 mm×5 mm) was removed with a drill in the anhydrous gel group and the hydrogel group, and the skull defect model was constructed. After establishing cranial defect models, the hydrogel group received blue light-cured hydrogel in the defect area, while the non-hydrogel group did not receive any filling. At 3 months post surgery, mechanical strength testing, RNA sequencing and immune microenvironment analysis were performed to systematically evaluate the repair effects and biological mechanisms of the hydrogel.

The hydrogel group showed uniform and continuous repair structures in the defect area, with mechanical strength (4.02±0.36 N) comparable to that of the healthy control group (4.21±0.27 N, P>0.05) and both significantly higher than that of the non-hydrogel group (1.74±0.21 N, both P<0.001). Immune cell heatmap analysis demonstrated significantly reduced inflammatory responses in the hydrogel group, with decreased expression of M1 macrophage markers (NOS2, IL12B) and increased expression of M2 macrophage markers (ARG1, MRC1, IL10) (all P<0.05). RNA sequencing showed that the hydrogel group significantly inhibited inflammation-related pathways (e.g., leukocyte migration, inflammatory cascades) and enriched pathways related to extracellular matrix remodeling and tissue repair (e.g., extracellular matrix-receptor interaction, negative regulation of fibrinolysis).

Hydrogels based on blue light curing have good skull defect repair effects. The mechanism may be related to inhibiting inflammatory responses and regulating the immune microenvironment.

Low incidence of symptomatic central retinal artery embolism due to embolic detachment during carotid stenting. In March 2024, the Department of Interventional Neurology of Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with severe right ICAC1 stenosis with balloon dilatation of right internal carotid artery segment C1 (ICAC1) + stent placement; Intraoperative angiography showed that the right ophthalmic artery was not developed, and a protective umbrella was placed at the distal end of right ICAC1. The operation went smoothly, and the patient was found to be completely blind in the right eye immediately after the operation. Embolism of the central retinal artery due to embolic detachment causing blood supply to the external carotid artery is considered. Through microcatheter superselection, the treatment was improved after urokinase thrombolysis. Three days after surgery, the patient complained of local black shadow in the right eye, some defects in the visual field, and good visual acuity.

In order to find out the gap in ethics construction of domestic and foreign neurosurgery journals and put forward suggestions for improvement, this study selected 6 kinds of foreign and 6 kinds of domestic neurosurgery journals. By comparing the requirements of ethics review in their manuscript or submission instructions (6 items in total), it was found that there are general problems of lack of ethical items or insufficient descriptions in domestic journals, while the requirements of ethics review in foreign journals are relatively perfect. In order to improve this situation, it is suggested that domestic journals should improve their ethical awareness, improve the ethical requirements in manuscripts and update them regularly, focus on clinical trials and laboratory animal welfare, and take corresponding countermeasures in combination with the discipline characteristics of neurosurgery. At the same time, strengthen the ethical awareness training of editors and authors, and promote the practical application of ethical principles, so as to enhance the credibility and academic influence of journals.

Many factors can cause optic nerve injury, sellar area occupation and sellar area surgery are the common causes of optic nerve injury. In the process of diagnosis and treatment of sellar area occupation, two problems deserve attention: first, how to accurately evaluate the optic nerve function through existing means, and evaluate the prognosis based on this; Secondly, how to effectively treat the damaged optic nerve, so as to maximize the prognosis of patients. Focusing on these two problems, this article reviews the anatomy of optic nerve and its diagnosis and treatment after injury.

Cerebral aneurysm is one of the most common causes of subarachnoid hemorrhage, and its pathogenesis has been the focus of clinical research. However, the risk of brain tumor patients with cerebral aneurysm is significantly higher than that of normal people. Brain tumor may affect the occurrence of cerebral aneurysm through local hemodynamic changes, tumor cell invasion, hormone action and iatrogenic damage, that is, brain tumor-related cerebral aneurysm. This article comprehensively reviews the research status of brain tumor-related cerebral aneurysm, covering the basis, clinical characteristics, mechanism, prevention and treatment measures that may lead to cerebral aneurysm by brain tumor, in order to provide reference for the prevention and treatment of brain tumor-related cerebral aneurysm.

Chronic subdural hematoma is a common disease in neurosurgery. In traditional treatment, patients with asymptomatic or mild symptoms are mostly treated conservatively, while those with large hematoma or obvious symptoms need surgical intervention, but the postoperative recurrence rate is higher. In recent years, middle meningeal artery embolization has gradually become an important alternative or adjuvant surgery as a minimally invasive endovascular treatment method that reduces the risk of recurrence by blocking the main blood-supplying artery of hematoma. This article systematically reviews recent studies on middle meningeal artery embolism, and summarizes its indications, contraindications, efficacy and safety.