Volume 41 · Issue 05 · 2025

The spinal cord subspecialty of Chinese neurosurgery is based on microsurgical technique, starting from the surgical treatment of spinal canal tumors, tethered cord, spina bifida and other diseases. After years of development, it has made remarkable progress in the treatment of a variety of spinal cord diseases. Spinal internal fixation technology has been evolving since its birth in 1891, and now it has been widely used in the treatment of various spinal cord and spinal diseases. Spinal internal fixation technology is of great significance in the spinal cord specialty of neurosurgery. It can not only ensure the stability of the spine, improve the treatment effect of common and complex spinal cord diseases, but also change the treatment methods of many surgeries, and plays an important role in the development of neurospinal surgery. However, this technique has clear surgical indications, and neurosurgeons need to strictly grasp its application principles and apply it scientifically and reasonably. With technological innovation and combined application with other technologies, spinal internal fixation technology will provide patients with better quality and reliable treatment plans, and will also promote the further development of spinal cord surgery.

To investigate the safety and clinical efficacy of one-stage surgical strategies for intramedullary spinal cord tumor resection and scoliosis correction.

A retrospective study was conducted on the clinical data of patients diagnosed with intramedullary spinal cord tumors and spinal scoliosis who underwent surgical treatment at the Spine Center, Sanbo Brain Hospital, Capital Medical University from January 2014 to June 2023. According to different surgical methods, patients were divided into the one-stage surgery group (12 cases) and the staged surgery group (6 cases). Surgery-related indicators such as the operation time, intraoperative blood loss and fusion segments, as well as the imaging data such as the Cobb angle of scoliosis and/or kyphosis, tumor location and size of the patients were record and analyzed. Neurologic function before and after surgery was evaluated according to the modified McCormick scale and Klekamp-Samii score, and there was no statistical significance in modified McCormick scale or Klekamp-Samii score between the two groups before surgery (both P>0.05).

All 18 cases were successfully operated. Among them, total resection was performed in 13 cases, subtotal resection in 4 cases and partial resection in 1 case. Compared with the stage operation group, the operation time (525.8±150.9 min vs. 849.2±195.3 min) and hospital stay (24.9±4.6 d vs. 44.0±15.5 d) in the stage operation group were reduced, and the differences were statistically significant (both P<0.05). There were no significant differences in tumor length, fusion segment or intraoperative blood loss between the two groups (all P>0.05). In addition, there was no significant difference in the incidence of postoperative complications between the two groups (χ²=0.11, P=0.737). One year after surgery, the correction rates of lateral curvature in the first and stage operation groups were (64.3±14.5) % and (68.4±64.4) % respectively, with no statistical significance (t=-0.65, P=0.526). In terms of neurological function at 1 year after surgery, there was no significant difference in Klekamp-Samii scores between the two groups (t=0.34, P=0.739). Among the 18 patients, 8 patients had modified McCormick grade Ⅰ, 7 patients had modified McCormick grade Ⅱ, 2 patients had modified McCormick grade Ⅲ, and 1 patient had modified McCormick grade Ⅳ. There was no significant difference in modified McCormick grade between the two groups (χ²=1.29, P=0.733).

One-stage surgery can significantly reduce the operation time and hospital stay without increasing the risk of nerve injury and the occurrence of complications, and it can be used as a surgical treatment option for intramedullary spinal cord tumors accompanied with scoliosis.

To explore the feasibility and clinical efficacy of suboccipital extreme lateral approach for the resection of C_1-2 spinal canal dumbbell tumors.

A retrospective analysis was conducted on the clinical data of 43 patients with C_1-2 dumbbell shaped tumors in the spinal canal who underwent suboccipital extreme lateral approach surgery in the Neurosurgery Department of Fuzong Clinical Medical College of Fujian Medical University (No.900 Hospital of PLA Joint Logistics Team) from February 2016 to May 2022. Regular clinical and imaging follow ups were conducted after surgery. The Japanese Orthopaedic Association (JOA) scores of cervical spondylosis patients before surgery, 3 months after surgery, 1 year after surgery, and at the last follow-up were determined. The McCormick spinal cord function scores before surgery and at the last follow-up, and the C_2-7 sagittal vertical distance (SVA) on CT reconstruction images were compared to comprehensively evaluate the efficacy and safety of the surgery.

Forty-three patients underwent complete tumor resection in one stage. All patients underwent follow-up after surgery, with a follow-up time [M(Q₁, Q₃)] of 32 (24, 45) months. The JOA scores at 3 months, 1 year, and the last follow-up after surgery were 14.79±1.25 points, 15.84±1.04 points, and 16.30±0.77 points respectively, which were all higher than preoperative conditions (13.67±1.08 points), with significant differences (all P<0.001). At the last follow-up, the McCormick spinal cord function score [M(Q₁, Q₃)] decreased from 2 (1, 2) points preoperatively to 1 (1, 1) points (Z=-4.97, P<0.001), and C_2-7 SVA decreased from 16.64±3.20 mm preoperatively to 15.51±3.33 mm (t=5.06.P<0.001). All patients underwent imaging reexamination and no tumor recurrence was found. No cases of cervical instability were observed.

Surgery via suboccipital extreme lateral approach can safely and effectively remove C_1-2 spinal cord dumbbell tumors in one stage, while preserving the C_1-2 bone structure and spinal stability to the greatest extent possible. When dealing with upper cervical spinal canal dumbbell tumors growing laterally, with external part of spinal canal larger than intraspinal part, it can be used as a preferred surgical approach.

To investigate the clinical effects of three-dimensional (3D) printed atlantoaxial intra-articular cages for basilar invagination with atlantoaxial dislocation (BI-AAD).

A retrospective analysis was conducted on the clinical data of 12 patients with BI-AAD underwent 3D printed atlantoaxial intra-articular cages implantation in the Spine Center, Sanbo Brain Hospital, Capital Medical University from January 2022 to January 2024. Postoperative complications were observed and documented. Postoperative neurological function was categorized as improved, stable, or deteriorated based on clinical presentation. All patients underwent follow-up cervical CT and MRI three months post surgery. Measurements on cervical CT included the distance from the odontoid process to the Chamberlain line (CLV), atlantodental interval (ADI), the clivoaxial (CXA) and the stability of the implants. Cervical magnetic resonance imaging (MRI) was used to measure the cervicomedullary angle (CMA). Preoperative and postoperative measurements were compared using paired t-tests to evaluate the reduction effectiveness.

All 12 patients successfully underwent surgery, with occipital-cervical fixation performed in each case. During the procedure, one patient experienced dural tear, and another required resection of the C₂ nerve root. However, no vertebral artery injuries were reported. Postoperatively, one patient developed a pulmonary infection. Eleven patients showed improvement in neurological function, while one remained stable. At the three-month follow-up, significant reductions were observed compared with preoperative measurements: the CLV decreased from 9.4±3.2 mm to 4.2±3.0 mm (paired t=8.91, P<0.001), and the ADI decreased from 4.8±1.2 mm to 2.0±1.6 mm (paired t=7.07, P<0.001). Additionally, the CXA increased from 139.9°±10.3° to 145.2°±6.8° (paired t=-2.60, P=0.025), and the CMA increased from 132.7°±18.8° to 146.7°±16.7° (paired t=-3.55, P=0.005). At the three-month follow-up, all implants were stable, with no cases of implant loosening or displacement.

The use of 3D printed atlantoaxial intra-articular cages for the treatment of patients with BI-AAD has been found to be relatively safe and effective. This approach can improve neurological function in patients, achieve satisfactory reduction and maintain short-term stability of the implant postoperatively.

To explore the efficacy of surgery involving the application of zero-profile fusion cage and conventional fusion cage in the treatment of three segment cervical spondylotic myelopathy.

The clinical data of 40 patients with cervical spondylotic myelopathy of three levels in the Department of Spine Surgery, Xi′an No.3 Hospital from January 2020 to January 2023 were analyzed retrospectively. The patients were divided into two groups according to the surgical method: conventional fusion cage group (n=19) and zero-profile fusion cage group (n=21). The baseline data of the two groups were well matched. Patients were clinically and radiologically evaluated before surgery, on the first day after surgery, and one year after surgery. The surgical outcome was assessed using the Japanese Orthopaedic Association (JOA) score, while the degree of pain was evaluated using the visual analog scale (VAS). Swallowing function was assessed using the standardized swallowing difficulty evaluation criterion. Cervical sagittal parameters were measured, which included cervical lordotic angle to evaluate cervical curvature and height of the surgical segment intervertebral space to assess surgical effectiveness. The results of postoperative complications were documented.

Two groups of patients underwent successful surgeries and achieved interbody fusion. No postoperative infections, esophageal, airway, dural injuries, or deaths occurred. The operation durations for the zero-profile fusion cage group and the conventional fusion cage group were 93.5±7.1 minutes and 105.4±8.8 minutes respectively and the intraoperative blood loss volumes were 46.7±12.2 ml and 48.0±11.9 ml respectively. These differences were not statistically significant (both P>0.05). On the first day after surgery, all 40 patients experienced dysphagia. In the zero-profile fusion cage group, 13 out of 21 patients had mild dysphagia, and 8 had moderate dysphagia. In the conventional fusion cage group, 11 out of 19 patients had mild dysphagia, 6 had moderate dysphagia, and 2 had severe dysphagia. The difference between the two groups was not statistically significant (U=183.50, P=0.680). The results of repeated measures ANOVA showed that the JOA score, VAS score, cervical lordosis angle, and intervertebral height of the two groups of patients gradually improved with time, and the differences were statistically significant (all P<0.05). However, at the same time points, there were no statistically significant difference in surgical efficacy between the two groups (all P>0.05). One year after surgery, 4 patients developed adjacent segment disease, including 1 in the zero-profile fusion cage group and 3 in the conventional fusion cage group. Seven patients experienced dysphagia, including 2 in the zero-profile fusion cage group (both mild) and 5 in the conventional fusion cage group (4 mild and 1 moderate). These differences were not statistically significant (both P>0.05).

The zero-profile fusion cage and the conventional fusion cage have comparable efficacy in the treatment of three-segment cervical spondylotic myelopathy. Patients using the zero-profile fusion cage may have better potential for reducing postoperative complications.

To investigate the efficacy of modified anterior controllable ante-displacement and fusion (ACAF) surgery for cervical ossification of the posterior longitudinal ligament (OPLL).

A retrospective analysis was conducted on the clinical data of 21 patients with cervical OPLL treated with modified ACAF under the microscope at the Department of Neurosurgery, Zhejiang Provincial People′s Hospital from June 2021 to June 2023. The postoperative complications were documented. Clinical and imaging follow-up was performed every 6 months post surgery. The surgical efficacy was evaluated using the Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) score for neurological function and pain assessment respectively. Imaging examinations were performed to evaluate the Cobb angle, spinal canal invasion rate, spinal cord anterior posterior diameter, spinal cord area, and Kang spinal canal stenosis grading. The Bridwell standard was used to assess the fusion of bone graft at the site of vertebral body retraction.

All 21 patients underwent successful surgery. A total of 52 vertebral bodies were anteriorly displaced, including 13 cases involved 3 vertebral bodies, 5 cases involved 2 vertebral bodies, and 3 cases involved 1 vertebral body. Postoperative complications included dysphagia in 2 cases, C₅ nerve palsy in 1 case, and cerebrospinal fluid leakage in 1 case. No instances of spinal cord injury, cervical hematoma, esophageal injury, or other serious complications were observed during the perioperative period. The follow-up time of 21 patients was 19.6±7.4 months (12-36 months). Up to the last follow-up, compared with those before surgery, JOA score [M(Q₁, Q₃), 16(15, 16)points vs. 13(12, 14)points], VAS score [M(Q₁, Q₃), 0(0, 1)points vs. 4(2, 5)points], C_2~7 Cobb angle (21.5°±3.0°vs. 15.6°±4.4°), spinal canal encroachment rate [M(Q₁, Q₃), 7.2(2.8, 14.8)% vs. 46.0(38.5, 59.6)% ], spinal sagittal diameter (7.1±0.9 mm vs. 4.9±1.1 mm), spinal area (73.6±13.9 mm²vs. 59.0±13.3 mm²) and Kang spinal stenosis grading [M(Q₁, Q₃), 0(0, 1) vs. 3(3, 3)] were improved, and the differences are statistically significant (all P <0.001). The fusion results of 104 bone grooves were classified as Bridwell grade Ⅰ in 89 cases and grade Ⅱ in 15 cases. No significant loosening of internal fixation was observed in the 21 patients.

The use of improved ACAF surgery for the treatment of severe cervical OPLL can safely and effectively lift the vertebral body, improve the success rate of surgery, and achieve good clinical efficacy.

To compare the effectiveness of unilateral biportal endoscope (UBE) technique with percutaneous endoscopic interlaminar (PEI)technique for the treatment of lumbar disc herniation.

The clinical data of 52 LDH patients treated by UBE or PEI technique in the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University from January 2021 to June 2023 were retrospectively analyzed. The patients were divided into UBE (24 cases) and PEI group (28 cases). We compared the incision length, operation time (external and intraperitoneal use), intraoperative fluoroscopy times, amount of irrigation fluid, postoperative hospital stay, surgical complications, visual analogue scale (VAS) score of lumbar and leg pain before and at 3 days, 3 months and 6 months after surgery, the Oswestry Disability Index (ODI) and modified MacNab function score at 6 months after surgery between the two groups.

Compared with PEI group, the overall operation time of UBE group was shortened (67.17±22.37 min vs. 76.07±8.39 min), but the extraspinal operation time was extended(44.46±4.99 min vs. 24.61±4.63 min), the incision was longer (14.25±1.40 mm vs. 6.96±0.70 mm), and the amount of flushing fluid was larger (14.25±1.40 mm vs. 6.96±0.70 mm), with statistical significance (all P < 0.05). There was no significant difference in the times of intraoperative fluoroscopy or postoperative hospital stay between the two groups (both P > 0.05). A total of 5 cases of dural tear occurred in the two groups, including 2 cases in the UBE group and 3 cases in the PEI group. There were no other serious complications in the perioperative period. There was no significant difference in surgical complications between the two groups (χ²=0.09, P = 0.772). Postoperative VAS scores and ODI of lower back pain and leg pain in 2 groups were decreased compared with those before surgery, and the differences were statistically significant (all P < 0.05). The VAS scores and ODI of low back pain and leg pain 3 and 6 months after surgery were lower than those 3 days after surgery, and the differences were statistically significant (all P < 0.05). At 3 days after surgery, the VAS score of low back pain in UBE group was higher than that in PEI group (3.99±0.51 points vs.2.92±0.69 points, P < 0.001), while there were no statistically significant differences in VAS score and ODI of low back pain and leg pain at other time points between the two groups (all P > 0.05). MacNab grading at 6 months after operation showed that among the 24 UBE patients, 19 cases were excellent, 4 cases were good, 1 case was fair, and the excellent and good rate was 95.83%. Among the 28 patients in PEI group, 22 cases were excellent, 5 cases were good, 1 case was fair, and the excellent and good rate was 96.43%. There was no significant difference in MacNab grading between the two groups (Z=-0.04, P=0.970).

Both UBE and PEI can effectively relieve the symptoms of lumbar and leg pain caused by lumbosacral LDH, and both are safe and effective surgical methods.

To investigate the individualized surgical treatment strategies and clinical outcomes for lower cervical (C₃-C₇) AO type C fractures with articular process interlocking or apposition.

A retrospective analysis was conducted on 20 patients with lower cervical AO type C fractures accompanied by articular process interlocking or apposition who underwent surgical treatment at the Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University between December 2020 and January 2024. All patients underwent skull traction under general anesthesia. For successful intraoperative facet joint reduction, anterior cervical approach was primarily performed: anterior cervical corpectomy and fusion (ACCF) for patients with burst vertebral fractures, and anterior cervical discectomy and fusion (ACDF) for those without vertebral fractures. Patients with unreduced facets underwent posterior cervical decompression with bone grafting and internal fixation. Intraoperative ultrasound was used to assess the anterior spinal cord decompression: patients with adequate decompression received staged ACCF/ACDF, while those with residual compression underwent combined anterior-posterior approach. Postoperative cervical three-dimentional CT and MRI were performed within one week to confirm reduction and decompression. Neurological outcomes were evaluated using ASIA (American Spinal Injury Association) impairment scale and JOA (Japanese Orthopeadic Association) scores at 1-week and 6-month follow-ups.

Intraoperative traction achieved complete facet reduction in 10 cases (1 bilateral and 2 unilateral interlocking, 7 apposition). Among these, 5 patients with burst fractures underwent ACCF and 5 received ACDF, all with supplemental posterior stabilization. The remaining 10 patients (8 bilateral and 2 unilateral interlocking) required primary posterior approach, with 7 undergoing simultaneous anterior procedures and 3 scheduled for staged anterior fixation based on satisfactory ultrasound decompression. All cases achieved anatomical reduction and adequate decompression. No intraoperative vascular or visceral injuries occurred. One patient died from high cervical cord injury complications 10 days postoperatively, while 3 discontinued treatment. Follow-up of 16 patients revealed ASIA grade improvements in 12 cases, no change in 4 cases (grade A: 2, grade B: 3, grade C: 3, grade D: 2, grade E: 6). Median JOA scores improved from preoperative 5.5 (2.5-7.5) points to 7.5 (5.0-12.0) points at 1 week and 9.5 (6.0-14.0) points at 6 months, with improvement rates of 17.4% and 34.8% respectively.

Treatment algorithm based on intraoperative traction reduction outcomes and real-time ultrasound decompression assessment demonstrates favorable surgical reduction quality while minimizing unnecessary surgical trauma, effectively improving neurological recovery in patients with complex lower cervical fractures.

To establish a new sagittal evaluation parameter for the cervical spine, the horizontal-view axis angle, based on X-ray imaging, and to investigate its role in reducing craniocervical junction instability.

This retrospective study included 147 asymptomatic individuals who underwent cervical spine X-ray examinations at the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University between November 2018 and February 2025 and had no spinal cord or spinal diseases. The horizontal-view axis angle was defined as the angle between the line connecting the deepest point of the nasal bone to the tip of the clivus and the tangent line along the posterior edge of the C₂ vertebral body. The horizontal-view axis angle was measured in male and female subjects, and its correlation with the C₂-C₇ angle was analyzed. Additionally, 8 patients who underwent surgery for craniocervical junction instability during the same period were included, 1 with atlantoaxial dislocation, 5 with basilar invagination and atlantoaxial dislocation, and 2 with atlantoaxial dislocation and odontoid free ossicle. During surgery, sagittal cervical spine reduction was guided intraoperatively using the horizontal-view axis angle, with the target angle set at approximately 90° under C-arm X-ray imaging. Postoperative cervical spine X-rays were taken on day 1 to assess reduction, based on odontoid anatomical structures, atlantodental interval, clivus-axis angle, and C₂-C₇ angle. Spinal cord function recovery was assessed using the Japanese Orthopaedic Association (JOA) scoring system, with an improvement of ≥1 point indicating functional recovery.

Among the 147 asymptomatic individuals, the horizontal-view axis angle was 90.1±5.5° in males and 90.2±4.7° in females, with no significant difference (P=0.865). Pearson correlation analysis showed significant negative correlation between the horizontal-view axis angle and the C₂-C₇ angle in both males (r=-0.52) and females (r=-0.51) (both P<0.001). In the 8 patients, the preoperative Horizontal-view axis angle was 73.8±13.0°, increasing to 90.4±0.7° after intraoperative reduction and 91.2±1.8° on postoperative day 1. The preoperative C₂-C₇ and clivus-axis angles were 41.9±8.9° and 104.0±14.3° respectively, improving to 27.7±3.5° and 153.7±2.9° on postoperative day 1. Among these patients, the atlantodental interval was ≤3 mm in 1 case of atlantoaxial dislocation and in 5 cases of basilar invagination with atlantoaxial dislocation. The 2 patients with atlantoaxial dislocation and odontoid free ossicle showed restoration of normal odontoid anatomy. All 8 patients had improvement of 1-2 points in the JOA scores.

The sagittal horizontal-view axis angle is a simple, reproducible parameter for cervical spine evaluation. It is a valuable intraoperative guide for reducing craniocervical junction instability and provides a reliable metric for postoperative assessment.

To analyze the risk factors that affect the severity of preoperative clinical symptoms in patients with spinal dural arteriovenous fistula (SDAVF).

A retrospective study was conducted on 77 patients with SDAVF admitted to the Neurosurgery Department of Tianjin Medical University General Hospital from January 2019 to October 2024. All patients were diagnosed with single fistula SDAVF through digital subtraction angiography (DSA). The severity of preoperative symptoms in patients was evaluated using the modified Aminoff Logue Scale (mALS) score, with ≤ 6 points in the mild group and 7-11 points in the severe group. We observed the extent of spinal cord edema and spinal cord enhancement signals through MRI. The position of the fistula opening through DSA was documented and hemodynamic indicators were calculated which included the diameter, blood flow velocity and blood flow rate of the drainage vein near the fistula opening. We then compared the differences in general clinical data, imaging, and hemodynamic factors between the mild and severe mALS score groups. Multiple logistic regression analysis was conducted to identify the risk factors affecting preoperative mALS scores in patients.

According to the preoperative mALS scores, there were 40 cases in the mild group and 37 cases in the severe group. Compared with the mild group, the severe group had a larger range of spinal cord edema, higher proportion of spinal cord enhancement, larger average diameter of drainage veins and slower blood flow velocity, with statistically significant differences (all P<0.05). There was no statistically significant difference in gender, age, or disease duration between the two groups (all P>0.05). Multivariate logistic regression analysis showed that large range of spinal cord edema (OR=2.13, 95%CI: 1.24-3.67, P=0.006), large diameter of draining veins (OR=1.32, 95%CI: 1.05-1.65, P=0.018) and slow blood flow velocity (OR=0.64, 95%CI: 0.48-0.86, P=0.004) were independent risk factors affecting the severity of preoperative symptoms in patients with SDAVF.

The hemodynamics near the SDAVF fistula are closely related to the severity of clinical symptoms in patients.

To explore the application value of high-resolution MRI in the diagnosis and treatment of spinal arteriovenous fistula (SAVF).

A retrospective analysis was conducted on the clinical data of 35 SAVF patients who underwent surgical treatment in the Department of Neurosurgery, the First Affiliated Hospital of Nanchang University between May 2018 and January 2024. All patients underwent preoperative high-resolution MRI scans, including contrast-enhanced MRA (CE-MRA) and three-dimensional Sampling Perfection with Application-optimized Contrasts using different flip-angle Evolutions (3D-SPACE), followed by spinal digital subtraction angiography (DSA) to localize the fistula. Intraoperative fistula identification served as the gold standard. Postoperative follow-up within 6 months included regular assessments using the modified Aminoff-Logue Scale (mALS) and the American Spinal Injury Association Motor Score (ASIA-MS) to evaluate neurological function, as well as high-resolution MRI to assess fistula recurrence and spinal cord edema resolution. Kappa testing was used to compare the diagnostic accuracy of DSA and combination of 3D-SPACE and CE-MRA for SAVF, and simple linear correlation analysis was performed to evaluate relationships between MRI findings and clinical factors.

Among the 35 SAVF patients, 32 had spinal dural arteriovenous fistula (SDAVF) and 3 had perimedullary arteriovenous fistula (PMAVF). The diagnostic accuracy of high-resolution MRI for fistula localization was 88.6% (31/35), compared to 85.7% (30/35) for DSA, with strong agreement between the two methods (kappa=0.61, P<0.001). The diagnostic accuracy of the 3D-SPACE sequence for vascular flow voids was higher than that of conventional MRI [100.0% (35/35) vs. 68.6% (24/35), U=525.00, P=0.022]. All fistulas were accurately localized and successfully resected. The preoperative and last follow-up mALS scores [median (range)] were 5 (2-11) and 2 (0-9), respectively. The preoperative and last follow-up ASIA-MS scores [median (range)] were 75 (40-86) and 91 (70-100), respectively. The differences were statistically significant (both P<0.05). Symptomatic improvement was observed in 28/32 SDAVF patients and in 3 PMAVF patients. Among 14 SDAVF patients who underwent follow-up MRI at 6 months, 12 showed resolution of spinal cord edema, all exhibited disappearance of vascular flow voids. No SAVF recurrence was observed in 35 SAVF patients. Correlation analysis revealed that the number of spinal cord edema segments in SDAVF correlated with preoperative symptom duration (R²=0.16, P=0.013) and the extent of vascular flow voids correlated with preoperative ASIA-MS scores (R²=0.11, P=0.035). No significant correlations were found among other variables (all P>0.05).

High-resolution MRI is valuable for diagnosis and postoperative evaluation in SAVF management, demonstrating significant clinical utility.

To preliminarily analyze the safety and efficacy of the Lattice flow diverter (LFD) in the treatment of intracranial aneurysms.

A retrospective analysis was conducted on the clinical and imaging data of 17 patients with 30 intracranial aneurysms treated with LFD in the Interventional Radiology Department of the Affiliated Taizhou People′s Hospital of Nanjing Medical University from January 2023 to May 2024. Imaging follow-up was performed 6 months after operation, and the occlusion of aneurysms was evaluated according to the O′Kelly-Marotta (OKM) grading system.

A total of 17 LFDs were implanted in 30 aneurysms of 17 patients (15 cases with simple LFD implantation and 2 cases with LFD combined with coil embolization), and the surgical success rate was 17/17. Two LFDs poorly adhered to the wall during operation, and one of them even presented filling defect at the distal end. They improved after symptomatic treatment. No patient suffered surgery-related cerebral ischemia or cerebral hemorrhage after surgery. Imaging follow-up was performed 6 months after operation in 11 patients (17 aneurysms). Among them, 15 aneurysms achieved healing with OKM grade D. one aneurysm showed shrinkage with OKM grade B, and the aneurysm disappeared one year later. one case was an internal carotid artery dissection aneurysm, and 6 months after operation showed no obvious change compared with before, with OKM grade A. One patient was found to have severe stenosis of the artery during follow-up but had no obvious cerebral ischemia manifestation.

Preliminary observations show that LFD is safe and effective in treating intracranial aneurysms.

To evaluate the efficacy of side-to-side (S-S) technique in superficial temporal artery-middle cerebral artery (STA-MCA) bypass for adult patients with Moyamoya disease (MMD), and to analyze the changes in cerebral hemodynamics.

A retrospective analysis was conducted on clinical data from adult MMD patients admitted into the Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January to November 2023. Patients were divided into two groups: the S-S group (25 cases) and the end-to-side (E-S) group (31 cases). Cerebral CT perfusion imaging was used to assess preoperative and postoperative perfusion changes in ipsilateral hemisphere. Intraoperative microvascular Doppler ultrasound was employed to collect hemodynamic parameters of the STA (proximal and distal portion, donor artery) and MCA [recipient artery(RA)] before and after bypass, including mean flow velocity (MVV) and its folds changes. The direction of blood flow in the RA was also recorded [entering the sylvian fissure (ES) or leaving the sylvian fissure (LS)]. The study compared the anastomotic longitudinal diameter/RA diameter ratio, duration of bypass anastomosis, therapeutic effects, postoperative complications, neurological outcomes at 6-month follow-up, Matsushima grading, bypass patency, cerebral perfusion, and hemodynamic parameters between the two groups.

The immediate patency rate of the bypass was 100% (56/56). Compared with the E-S group, the S-S group had a larger anastomotic longitudinal diameter/RA diameter ratio [M(Q₁, Q₃): 3.17 (2.91, 3.25) vs. 1.68 (1.31, 1.87), Z=6.37, P<0.001] and a longer bypass duration (27.36±4.06 min vs. 16.67±4.47 min, t=-8.97, P<0.001). Among the 56 patients, postoperative complications included cerebral infarction (5 cases), cerebral hemorrhage (5 cases), cerebral hyperperfusion syndrome (8 cases), and epileptic seizures (1 case). There was no statistically significant difference in the incidence of these complications between the two groups (all P>0.05). At the 6-month follow-up, there were no significant differences in neurological outcomes, Matsushima grading, or bypass patency between the two groups (all P>0.05). Before anastomosis, there were no significant differences in MVV_RA or the flow direction between the two groups (both P>0.05). After anastomosis, the S-S group showed significantly higher MVV_RA-ES, MVV_{post-anastomosis STA input}/MVV_{pre-anastomosis STA} and MVV_{post-anastomosis STA proximal}/MVV_{pre-anastomosis STA} compared with the E-S group (all P<0.05). However, there were no significant differences in MVV_{STA input}, MVV_{STA proximal}, or MVV_RA-LS between the two groups (all P>0.05). Postoperative perfusion comparisons revealed no significant differences in collateral vessel density, core infarct volume, hypoperfusion volume, severe hypoperfusion volume, hypoperfusion index, penumbra volume, or hypoperfusion-infarct core mismatch rate between the two groups (all P>0.05).

The STA-MCA bypass with S-S anastomosis in adult patients with MMD results in similar cerebral perfusion changes, postoperative neurological outcomes, and complication rates to the traditional E-S technique. However, significant differences in cerebral hemodynamic parameters exist between the two groups.

To compare the efficacy of the neuroendoscopic anterior trans-middle frontal gyrus approach versus the microscopic transcranial trans-temporal cortical approach for surgical treatment of basal ganglia hemorrhage.

Clinical data of 148 patients with basal ganglia hemorrhage admitted to the Department of Neurosurgery, the Affiliated Suqian Hospital of Xuzhou Medical University from October 2018 to October 2023 were retrospectively analyzed. Patients were divided into the endoscopic group (n=93) and the microscope group (n=55) based on the surgical approach. Preoperative and postoperative cranial CT scans were conducted. The 3D Slicer software was utilized to evaluate hematoma and perihematomal edema (PHE) volumes, and the angles between the surgical trajectories of the two approaches and the hematoma long axis were measured and compared. Six-month outcomes were assessed using the modified Rankin Scale (mRS), with scores of 1-3 considered as favorable and 4-6 as unfavorable. Comparative analysis of surgical efficacy differences was conducted between endoscopic group and microscope group patients.

Compared with the microscope group, patients in the endoscopic group had shorter surgical duration, higher hematoma clearance rate, and smaller PHE volume on the 5th day after surgery (all P<0.001). No significant differences were observed in hospital stay, postoperative day 7 Glasgow Coma Scale (GCS) scores, or complication rates (all P>0.05). Additionally, the endoscopic group had a significantly smaller angle between the surgical trajectory and the hematoma long axis [(37.9±7.1)° vs.(74.3±9.1)°, t=38.37, P<0.001]. At 6 months, patients in the endoscopic group demonstrated lower mRS scores (3.7±1.1 vs. 3.0±1.0, t=3.96, P<0.001) and a higher proportion of favorable outcomes [43.6%(24/55) vs.67.7%(63/93), χ²=8.29, P=0.004]. Among those with favorable outcomes, the endoscopic group also had significantly lower postoperative PHE volumes on the 5th day after surgery (14.2±5.6 ml vs. 18.5±3.0 ml, t=4.62, P<0.001).

Compared with the conventional trans-temporal cortical approach, the neuroendoscopic approach via the anterior middle frontal gyrus offers advantages of shorter operative time, higher hematoma clearance, reduced postoperative PHE, and improved long-term outcomes in patients with basal ganglia hemorrhage.

To compare the anatomical exposure differences between the retrosigmoid approach (RSA) and the translabyrinthine approach (TLA) in acoustic neuroma surgery from an anatomical perspective, and to provide a basis for clinical decision-making.

Six adult cadaveric heads (12 sides) were used to simulate the surgical procedures of the RSA and the TLA. Microanatomical observation and measurement were conducted to compare the procedural workflow, exposure range of anatomical structures, and critical anatomical parameters, including: lengths of the anterior and posterior walls of the internal auditory canal (IAC), distance from the posterior wall of the IAC to the common crus, distance from the IAC orifice to surrounding dura and the sigmoid sinus, and the distance from the origin of the vertical segment of the facial nerve to the mastoid cortical surface.

The lengths of the anterior and posterior walls of the IAC were 15.24±1.44 mm and 9.74±0.91 mm, respectively. The distance from the posterior wall of the IAC to the common crus was 9.44±0.64 mm. In the RSA, the distance from the posterior wall of the IAC orifice to the cranial surface was 42.36±5.88 mm, and the distance from the mastoid emissary vein to the posterior wall of the sigmoid sinus was 13.21±3.56 mm. In the TLA, the distances from the IAC orifice superiorly to the middle fossa dura, inferiorly to the dural reflection of the jugular foramen, and posteriorly to the anterior edge of the sigmoid sinus (parallel to the superior petrosal sinus) were 4.02±0.77 mm, 8.27±1.73 mm, and 23.25±1.71 mm, respectively. The distance from the origin of the vertical segment of the facial nerve to the mastoid cortical surface was 17.57±4.36 mm, and the distance from the posterior wall of the IAC orifice to the mastoid cortical surface was 36.63±3.97 mm. Anatomical observations revealed that the RSA provided a larger operative space but limited exposure of the fundus of the IAC, while the TLA allowed full exposure of the IAC but with a narrower operative space and susceptibility to interference with the vertical segment of the facial nerve.

The RSA provides a larger operative space and early exposure of the brainstem interface, whereas the TLA enables complete exposure of the IAC.

To investigate the molecular mechanism of VAMP8 in regulating the immune microenvironment of gliomas based on single-cell sequencing data and spatial transcriptomic data.

Utilizing the publicly available single-cell sequencing dataset (GSE117891), the expression characteristics of VAMP8 in different cell types within glioma tissues was analyzed using Seurat. Additionally, with the aid of publicly available spatial transcriptomic data, we employed SPATA2 software to verify the specific distribution of VAMP8 in glioblastoma. After subclustering macrophages using Seurat, we screened for differentially expressed genes using the "FindMarkers" function and then annotated the functions of these genes with ReactomePA and DAVID. Subsequently, we employed "CellChat" to analyze the impact of VAMP8 on intercellular communication and screened for significantly different ligand-receptor pairs.

After analysis of single cell data, 5 168 glioma cells were divided into four cell subpopulations. VAMP8 was highly expressed in some macrophages and lymphocytes and showed lower expression in tumor cells and oligodendrocytes. In spatial transcriptomic data, the spatial localization of VAMP8 was more consistent with that of tumor-associated macrophage markers CD68, colony stimulating factor 1 receptor, and triggering receptor expressed on myeloid cells 2. After subclustering macrophages, we found macrophages with high and low VAMP8 expression. Reactome pathway analysis revealed that high VAMP8 expression was associated with PD-1 signaling, MHC class Ⅱ antigen presentation, interferon γ signaling pathway, et al. (all P<0.05). In contrast, low VAMP8 expression was related to neutrophil degranulation, signaling by interleukins, GPCR ligand binding signaling pathway, et al. (all P<0.05). Biological process analysis indicated that high VAMP8 expression was linked to antigen processing and presentation, immune response, et al. while low VAMP8 expression was associated with neutrophil chemotaxis and inflammatory response, et al. (all FDR<0.05). Furthermore, anti-inflammatory factors CD163, colony stimulating factor 1 receptor, and macrophage scavenger receptor 1 were significantly overexpressed in the high VAMP8 expression subcluster compare to the low VAMP8 expression subcluster (all P<0.05), while pro-inflammatory factors prostaglandin-endoperoxide synthase 2 and tumor necrosis factor alpha-induced protein 2 were lowly expressed in this subcluster (all P<0.05). VAMP8 was able to enhance the intensity of cellular interactions but had no significant impact on the number of interactions in tumor microenvironment. Macrophages with high VAMP8 expression might enhance communication between macrophages and other cell types, especially tumor cells, by promoting interactions between secreted phosphoprotein 1(SPP1 ) and CD44, as well as SPP1 and ITGAV+ ITGB1.

High expression of VAMP8 enhances intercellular communication between macrophages and tumor cells in the glioma microenvironment, and then promotes the malignant progression of glioma.

Rosai-Dorfman disease (RDD) is a rare benign self-limiting histiocytosis with atypical clinical manifestations, easy misdiagnosis and misdiagnosis, and the related pathogenesis is still unclear. According to the site and extent of the lesion, RDD can be divided into lymph node type, extranodular type and mixed type, which can occur in all age groups. Treatment, for asymptomatic RDD patients, can be observed first; For symptomatic patients, surgical resection of the lesion is recommended; For patients with systemic and relapsed refractory RDD, systemic medication may be considered. This paper reports a patient with intraspinal epidural RDD treated by surgery and confirmed by pathology. Thoracic MRI follow-up 3 months after surgery showed no recurrence of the lesion.

Anterior choroidal artery (AChA) cisternal segment aneurysms are rare, mostly congenital, and the formation of some aneurysms is related to hemodynamics. Whole brain digital subtraction angiography is the "gold standard" for its diagnosis. The method of endovascular embolization can effectively treat AChA cisternal segment aneurysm. The Department of Neurosurgery of Binzhou People's Hospital successfully treated a patient with AChA cisternal segment aneurysm with stent-assisted coil embolization in December 2023; At 6 months postoperative follow-up, the patient had no neurological dysfunction.

The periodical column has the functions of guiding and indexing, and its design is reasonable or not related to the overall image and quality of the periodical. In this study, a combination of quantitative and qualitative analysis was used to compare and analyze the column setting of four kinds of neurosurgery journals at home and abroad. It is found that the column setting of domestic journals is relatively simple and standardized, but there are problems such as general column names and large differences in quantity, and there is a lack of interactive and humanistic care columns; Foreign periodical columns are more detailed and rich, covering a wide range, paying attention to interactivity and humanistic care. Based on this, it is suggested to optimize the column setting of neurosurgery journals in China, including the following aspects: while maintaining the stability of fixed columns, increasing the flexibility and diversity of mobile columns; Strengthen the characteristics of special columns and highlight the frontier of disciplines; Increase the proportion of commentary and opinion columns; Add interactive columns to enhance communication between editors, authors and readers; Strengthen the setting of humanistic care columns; And strive to achieve both internationalization and regionalization.

Severe traumatic brain injury is one of the leading causes of death and serious disability worldwide, placing a heavy burden on families and society. Since the primary brain injury in such patients is overwhelmingly irreversible, avoiding or alleviating secondary brain injury as much as possible may be crucial to improve the patient's prognosis. Therapeutic hypothermia is believed to prevent or reduce secondary brain injury after severe traumatic brain injury by exerting multiple neuroprotective effects, but clinical studies have shown inconsistent results. Therefore, this article reviews the application progress of therapeutic hypothermia in patients with severe traumatic brain injury, in order to provide reference for the clinical treatment of this kind of patients.